| NPI | 1770107856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L BASSO Owner 832-777-7570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2024-04-16 |