| NPI | 1053066357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARA BALES Nurse Practitioner 945-234-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2022-04-13 |