| NPI | 1477963072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES DEMARQUE Medical Director 817-308-8477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX J1969) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-05-05 |