| NPI | 1396245361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS D LAWS Adminstrator 817-791-1320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |