| NPI | 1871799510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Officer, Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IN 07-005650-1) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2017-09-28 |