| NPI | 1053608547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE SALES FORTE Physician Assistant 817-832-2964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX temporary license) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2011-07-05 |