| NPI | 1164647434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN L BERGSTROM CEO 817-277-9415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX G8579) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX L0505) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2016-02-22 |