| NPI | 1720081664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA C HODGES Credentialing Specialist 903-526-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TX 000377) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2023-08-09 |