| NPI | 1790023869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHALIE BLACKSTOCK Director, Billing 512-323-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G6955) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 08124) |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2013-01-24 |