| NPI | 1053789990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORNELIA S DERIESE Owner 888-753-5988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX L6348) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |