| NPI | 1225450893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES KEZENGWA Chief Executive Officer 817-405-9540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX MT2398) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |