| NPI | 1629688221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN BANNISTER Owner, President 972-890-2156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 133N00000X Nutritionist |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2020-08-07 |