| NPI | 1205241361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Officer / Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2017-09-20 |