| NPI | 1679963888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON FUSELIER Manager 903-927-2824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX AP126854) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2015-01-26 |