| NPI | 1841488582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD D EZZELL Owner/President 325-670-5740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX L4928) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2007-10-09 |