| 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 |