| NPI | 1659980159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY D MCDOUGAL Compliance Officer 870-489-7903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2022-06-16 |