| NPI | 1962143636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI ANN FOSTER Practice Administrator 817-692-4089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-05 |