| NPI | 1649427337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH PARK Owner 972-370-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L6563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M5418) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2013-08-28 |