| NPI | 1073061305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JONES Co Owner 469-877-1662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TX 32134) |
| Additional Taxonomies | 251S00000X (Licence: TX 34152) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2016-09-15 |