| NPI | 1528172012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIE SLATTERY Administrator 979-836-6153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX K6753) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F4241) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-10-27 |