| NPI | 1164381331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARAH GODINEZ Credentialing Manager 817-705-6517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2026-01-21 |
| Last Update Date | 2026-01-21 |