| NPI | 1649755570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN TRACE GEORGE Chief Operating Officer 325-701-9270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2022-08-15 |