| NPI | 1316579055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIDA PETTYJOHN Credentialing Acct Manager 512-454-5911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2023-04-19 |