| NPI | 1124243720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANNA RAE STEPHENSON President 512-419-0330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX F006749) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |