| NPI | 1447890397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM WILSON Admin 409-923-0012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2021-05-10 |