| NPI | 1447711007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELLA VICTORIA BUMSTEAD Administrator 409-429-8457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2021-09-14 |