| NPI | 1710246541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA M FONTENOT Provider 903-255-6398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX PA00982) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2012-05-14 |