| NPI | 1114127347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ROSE CHAMPAGNE-MILLER Administrator 512-225-6345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX H7829) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2012-10-04 |