| NPI | 1124346598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAINE RANDALL BLAKESTAD President 936-632-5894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX F1391) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2010-09-09 |