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 |