| NPI | 1245833243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISON TEMPLE Credentialing Administrator 817-655-2164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2020-11-20 |