| NPI | 1932936424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN TECONCHUK Chief Executive Officer 682-378-0808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2025-01-03 |