| NPI | 1891859476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK B RANDOLPH Physician 512-878-6330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: TX L8483) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2012-08-17 |