| NPI | 1609172527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKY PAUL SHORT Physician 817-295-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX K5401) |
| Enumeration Date | 2011-02-10 |
| Last Update Date | 2011-02-10 |