| NPI | 1093978603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH CAPRON Business Manager 817-681-3775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 036099609) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2008-07-03 |