| NPI | 1770207599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JEFFERSON Practice Consultant 972-999-1659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2025-10-20 |