| NPI | 1003166844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVELYN MAHONEY Credentialing Manager 512-485-7208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2023-08-28 |