| NPI | 1790241073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLIN LEMAISTRE Officer / Authorized Officer 469-250-3640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2020-11-06 |