| NPI | 1265085229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L BASSO Owner 682-647-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2024-04-29 |