| NPI | 1699021089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAZANE SHERILYN WALLS Clinical Manager Iii 972-861-5917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TX 15910) |
| Additional Taxonomies | 251S00000X (Licence: TX 8802) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |