| NPI | 1386426484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AL BERRY Manager 469-915-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2025-01-15 |