| NPI | 1174801377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RYAN THOMAS Member 1662-324-1097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MS 21408) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2011-07-22 |