| NPI | 1407968316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA KINNEY COUTANT Administrative Assistant 817-514-5258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX M2590) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |