| 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 |