| NPI | 1588023329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYCHELL THOMAS Director 769-216-1047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MS P330299) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |