| NPI | 1104217819 |
|---|---|
| Former Legal Business Name | NONE |
| Entity Type | Organization |
| Authorized Contact | CHARISE NOEL SULLIVAN CEO 832-870-3693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX 193200000X) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2015-02-17 |