| NPI | 1861941296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SULLIVAN BRYANT Owner 214-215-5440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: TX 1000061) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2020-01-30 |