| NPI | 1386032860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS A GATEWOOD Owner 469-450-0498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: TX 130237) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2017-03-01 |