| NPI | 1043580616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN GRANT Owner President 214-783-6769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 122300000X Dentist |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207T00000X Neurological Surgery | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |