| NPI | 1184610412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDDIE BARBER Operations Director 903-255-0220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA01831) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2020-08-22 |