| NPI | 1629531488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA MORAN Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |