| NPI | 1396073672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALDL WREYBURN PHILLEAUX Medical Doctor/Owner 214-357-9481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX D1883) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: TX D-1883) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2009-11-25 |