| NPI | 1972652600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM THOMAS Secretary 972-239-9252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 2080A0000X Pediatrics, Adolescent Medicine | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |