| NPI | 1265629398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACCI GAYLE WALDEN Owner 940-498-4445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX L4162) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2010-05-18 |