| NPI | 1912205337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE ANTHONY WASINGER President 214-300-1177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: KS 01-05352) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2011-03-09 |