| NPI | 1932080074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE MILLER Administrator 512-793-9148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-24 |