| NPI | 1902012677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE E KENNEDY Billing Manager 817-488-9991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: TX R30913) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-08-22 |