| NPI | 1356867014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERIC WILSON Authorize Office Official 512-858-7474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-08-15 |