| NPI | 1518787902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AL BERRY Manager 469-915-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| 213EP1101X Podiatrist, Primary Podiatric Medicine | |
| Enumeration Date | 2024-10-11 |
| Last Update Date | 2025-04-16 |