| NPI | 1033566286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYBURN WESLEY MITCHUM Director Of Business Development 936-553-3417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-05-23 |