| NPI | 1316430580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY K HAWKINS Provider/Owner 817-294-0934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX Q3197) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2019-05-16 |