| NPI | 1942060223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAKA-CON DAVIS Director/Owner 980-785-8566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-04-03 |