| NPI | 1497198147 |
|---|---|
| Former Legal Business Name | BROAD PARK IMAGING, LLC |
| Entity Type | Organization |
| Authorized Contact | JAMES A WALLER Manager 817-528-7044 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0200X Clinic/Center Radiology (Licence: TX R33761-000) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2013-04-12 |