| NPI | 1528451366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN JOHNSON Owner/ Practice Manager 409-722-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H5430) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-04-22 |