| NPI | 1255437414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY GIBSON Clinic Director 254-657-2839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: TX K9540) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |