| NPI | 1619864782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCHANEAKA ROBERTS Director Of Operations 270-900-0373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2025-06-21 |
| Last Update Date | 2025-07-21 |