| NPI | 1740508076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON FAIN NEVOIT Manager 817-321-4813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP0905X Clinic/Center, Public Health, State or Local (Licence: TX 105716) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2010-05-11 |