| NPI | 1235310590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE FUGATE Practice Administrator 903-531-9901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN H6140) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2025-05-19 |