| NPI | 1063955334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CORIA Owner 469-230-2291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX L1276) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2016-12-21 |