| NPI | 1215382213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE W BROCK Owner 409-599-6461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP109617) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2016-04-27 |