| NPI | 1881788834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA CARMEN JIRAU-ROSALY Family Physician 580-458-2411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: IN 01059043A) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |