| NPI | 1912659954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MARTIN President 469-215-3494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2022-01-20 |