| NPI | 1649568411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY WOOD Manager 325-226-3503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05955) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2011-07-14 |