| NPI | 1669420345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY JO BLANTON Provider Relations 903-595-6078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX H4166) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 30239) |
| 111NX0800X Chiropractor, Orthopedic (Licence: TX DC5099) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-08-22 |