| NPI | 1255703849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN NOBLE Approver 806-319-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA06036) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |