| NPI | 1811286875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA E SMITH Credentialing Coordinator 888-737-9615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: TX 26045) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2011-03-30 |