| NPI | 1093829509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN BOBBI KELEHAN Physician/Owner 903-927-2824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX L6234) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-08-22 |