| NPI | 1710205612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY M GRAVES Director Of Operation 409-795-9560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2010-05-17 |