| NPI | 1104078633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS BURKE Medical Director 210-340-9944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 7096) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2009-12-15 |