| NPI | 1730562026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE JEAN WALLUM Program Sponsor 903-571-2731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2023-08-22 |