| NPI | 1659961852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA JAMERSON Clinical Director 469-215-5713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2023-08-12 |