| NPI | 1689755266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL BRYAN BACAK President 979-695-3570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K5445) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2010-01-14 |