| NPI | 1912156324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE M MCDONALD Owner 940-381-0333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: TX 554644) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2008-09-10 |