| NPI | 1992700512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN ELIZABETH FOURTON Director 469-800-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX 00T27E) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2017-04-20 |