| NPI | 1114316429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCY JO THORNBURG Credential Manager 972-863-9047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX Q0843) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2015-01-12 |