| NPI | 1053551580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | POHN P INTHANOUSAY Owner/Doctor 817-704-6930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J9103) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-02-24 |