| NPI | 1306152103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA RACHELLE BAVOUSETT Nurse Practitioner/Owner 432-332-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX 657564) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2014-04-01 |