| NPI | 1972608636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENELOPE A. JACKSON Physician/Owner 817-579-1005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2014-04-02 |