| NPI | 1912721432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMA ROBERTS Admin 469-898-3694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-21 |