| NPI | 1548752850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LEIGH BACSIK Owner 817-946-0790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX M6511) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2018-06-01 |