| NPI | 1851018055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS CANTO COO 964-654-2350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261Q00000X |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2023-07-17 |