| NPI | 1821419201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKISHA HENDERSON Owner 469-360-6794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: TX 1000045) |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2020-05-29 |