| NPI | 1346751682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN DRU RIDDLE Managing Partner 817-734-7980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2017-10-13 |