| NPI | 1679727259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA DIANE LACKEY Office Manager 972-270-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX 667351) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2008-11-10 |