| NPI | 1619728243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH JACOBO Credentialing Manager 325-374-0821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-01 |