| NPI | 1649612110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES D. DEMARQUE Medical Director 817-308-8477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX J1969) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2013-07-24 |