| NPI | 1366879314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA RODRIGUEZ FULLER Owner 806-418-5880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 694365) |
| Enumeration Date | 2013-10-06 |
| Last Update Date | 2013-10-14 |