| NPI | 1730639113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESS EVANS CFO 469-296-1049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 207Q00000X Family Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2020-01-28 |