| NPI | 1679232508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE FULLER Co CEO 214-405-5556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2022-01-06 |