| NPI | 1518190545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE DENISE BURGESS Owner/President 940-243-0108 |
| Organization Subpart ? | |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX 9347) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2020-07-23 |