| NPI | 1982936555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE ALLEN HENRY Owner/ Provider 817-861-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H2454) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2010-02-10 |