| NPI | 1477937597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY JAMES LIESVELD Nurse Practitioner 972-258-7499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX AP128468) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2016-08-24 |