| NPI | 1962215848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIETA KAY GRISSMAN Owner 817-637-0363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-01-27 |