| NPI | 1760741219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN KRISTOFFERSON Owner/President 915915-474-1798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA02936) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2012-05-03 |