| NPI | 1508145871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES W FULLER Physician/Owner 325-675-0338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F3971) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2011-08-04 |