| NPI | 1720613094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROUSSEL CLEMENT Provider 832-286-1108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2020-03-07 |
| Last Update Date | 2022-03-29 |