| NPI | 1720085277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLIN LEMAISTRE Officer / Authorized Official 469-250-3640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: GA 060212) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2024-10-11 |