| NPI | 1215209838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY CELESTE BALLEW Owner 979-220-9406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: TX 564050000) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |