NPI | 1396174454 |
---|---|
Entity Type | Organization |
Authorized Contact | JENETHA D MORAN Authorized Official 972-763-3893 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ OSC6638) |
Enumeration Date | 2013-11-08 |
Last Update Date | 2019-07-26 |