NPI | 1043708019 |
---|---|
Entity Type | Organization |
Authorized Contact | KENYETTA MASHATT RN Administrator 469-409-1091 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
Enumeration Date | 2018-04-25 |
Last Update Date | 2019-04-18 |