| NPI | 1174135107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY REED Office Manager 972-413-9168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2021-01-12 |