| NPI | 1558794081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ OSC6367) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2019-07-26 |