| NPI | 1326582164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK W MCDONALD Owner 903-617-6856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2017-01-04 |