| NPI | 1477169076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT JOSEPH MANDOLA Physician/Owner 281-485-3226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2021-12-22 |