| NPI | 1376097493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNA BOUDREAUX VP Operations 469-422-0641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q9070) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX Q9070) |
| 207Q00000X Family Medicine (Licence: TX Q9070) | |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2019-02-07 |