| NPI | 1346270329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: VA OH686) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-12-04 |