| NPI | 1104541408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON BARNES Manager 972-872-8254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2022-10-10 |