| NPI | 1457731499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEREDITH COLEY RYAN Majority Member 817-253-7605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5608) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2015-06-04 |