| NPI | 1710425541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L. BISHOP Clinic Director 936-645-1586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2022-11-28 |