| NPI | 1962583930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LYNN SCHILLERSTROM Owner 210-680-5543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX M3083) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-08-14 |