| NPI | 1396259297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTE VAN EEDEN Manager 817-571-6505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: TX G0723) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: TX G0723) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2017-11-30 |