| NPI | 1730563610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Officer/Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2019-11-04 |