| NPI | 1376665349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSCOE C. LEWIS Director Medicaid Coordination 972-581-4793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |