| NPI | 1578018073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHODA KUTESA BICKERSTAFF Owner 817-249-9717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: TX AP130637) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2023-12-18 |