| NPI | 1700887155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON E COOKE Board Member 325-672-4372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TX 007182) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2014-06-23 |