| NPI | 1861677700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY SHEA Enrollment Specialist 817-484-6274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K0107) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2020-11-06 |