| NPI | 1114440963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Officer / Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2017-07-24 |