| NPI | 1588051114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS GREEN Owner 214-796-7205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2019-09-23 |