| NPI | 1437483583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES J. WILTRAUT Executive Director 972-682-8917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2018-08-20 |