| NPI | 1093006389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON LEE GALLENTINE Director 214-949-0130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1513) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2011-06-16 |