| NPI | 1356542419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA DRERUP Chief Manager 817-875-7336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TX App #08498) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2011-01-25 |