| NPI | 1346507209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNA RILEY Owner 432-638-4544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX 109122) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2012-09-14 |