| NPI | 1871147827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABREANNA FORD Manager 832-787-2834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2019-07-29 |