| NPI | 1265047666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMISHE FONTENOT Owner/Nurse Practitioner 682-804-8088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-10-14 |