| NPI | 1386518355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY ANGELL Admin 469-458-7335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2025-10-02 |
| Last Update Date | 2025-10-02 |