| NPI | 1316256563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY LYN WALDEN Practice Administrator 817-431-7985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX N6768) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2018-06-20 |