| NPI | 1619115995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY E ODOM Owner 817-738-9777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: TX DC5994) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2009-01-26 |