| NPI | 1184421935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN WALLS Owner 936-333-3532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2025-12-01 |