| NPI | 1538719471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WINIFRED RENE KING Owner 936-224-7990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2023-05-17 |