| NPI | 1457005548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN ERGANG Owner 210-630-0146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-02-15 |