| NPI | 1699562116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYCE L LARSEN Partner 254-640-1718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| 261QH0100X Clinic/Center Health Service | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-04-22 |