| NPI | 1740627512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTI M GANTT Owner 903-875-2188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA07344) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2015-09-25 |