| NPI | 1245290444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARA ASHLEY GREEN Practice Manager 512-637-4968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX L9417, L9110) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-08-22 |