| NPI | 1831582204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JACKSON Owner 214-227-2457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ AP4200) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2015-03-10 |