| NPI | 1790108454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONI LYNN SHEPHERD Owner 979-297-3949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX N6017) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2014-03-10 |