| NPI | 1053388223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANIE D WILSON Administrator 210-222-2154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TX 000175) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2019-03-22 |