| NPI | 1992764369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL MELANIE BREAUX Business Mgr 817-277-2671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2010-10-26 |