| NPI | 1689116832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY CASTILLO Manager 817-375-0537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: TX AP131658) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2016-11-04 |