| NPI | 1457993297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYE C KRUBALLY Owner 972-303-0861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 293D00000X Physiological Laboratory |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2021-04-23 |