| NPI | 1619479276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHABON S BURGESS Owner/Manager 580-933-9024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 293D00000X Physiological Laboratory |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2022-04-20 |