| NPI | 1578979902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BISHARA Owner 817-473-2120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TX N2005) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |