| NPI | 1619484482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY EARL WILSON Chief Executive Officer 769-218-7005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-01-03 |