| NPI | 1861972556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANIE SAMUELSON Billing Manager 817-778-9441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 207RI0200X Internal Medicine Infectious Disease |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-10-09 |