| NPI | 1407202484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM LIDBOM Billing And Credentialing 956-465-1091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2024-01-23 |