| NPI | 1922141738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7001969) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2018-09-18 |