| NPI | 1851668925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA E PROVIDENZA Administration 817-614-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: TX J6980) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2022-04-25 |