| NPI | 1881035004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | POLLY TEEN VICK Owner 254-535-6020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX 675722) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2013-09-10 |