| NPI | 1831118702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA BUTCHER Credentialing Coordinator 806-761-0333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX j7779) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-01-29 |