| NPI | 1679605372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE MENARD Director 940-898-3826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX J2202) |
| Additional Taxonomies | 261Q00000X (Licence: TX 11487) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2012-11-26 |