| NPI | 1891812087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONELLE W COUCH Business Office Manager 5504-887-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: LA 010614) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |