| NPI | 1710423371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA M BROWN Manager 817-405-7470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2019-01-28 |