| NPI | 1306106687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELENE MITCHELL ADIELE Owner 254-371-1172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J2678) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2013-12-17 |