NPI | 1972835502 |
---|---|
Entity Type | Organization |
Authorized Contact | JEFFREY M. RADACK Physician 469-742-0406 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: TX 1617) |
Enumeration Date | 2010-02-07 |
Last Update Date | 2021-12-14 |