| NPI | 1992713176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Officer / Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AZ OSC4133) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2018-05-31 |