| NPI | 1124201306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L CONLEY Billing 936-582-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H8025) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX H8031) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2007-12-11 |