| NPI | 1013094168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RON MANSOLO Medical Director 512-259-1433 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-11-10 |