| NPI | 1174726061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY TICKLE KOMENDA Office Manager 972-608-1868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: TX H6350) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2008-08-12 |