| NPI | 1053859637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH BORGMAN Provider/ Owner 346-808-5904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX AP120780) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2017-02-03 |