| NPI | 1801965652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RON MANSOLO Medical Director 512-848-4405 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-12-20 |