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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
JUSTINA LESTER (FOUNDER)
(870) 310-0222
Entity
Organization

Contact information

Practice address
4119 EAGLE DR, MANSFIELD, TX 76063-5476
(870) 310-0222
Mailing address
4119 EAGLE DR, MANSFIELD, TX 76063-5476
(870) 310-0222

Taxonomy

Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
38982007
TX
Enumeration date
08/01/2022
Last updated
08/01/2022
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Product
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