| NPI | 1124423736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEONTE BROUSSARD Counselor 832-689-9460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 70182) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2014-10-24 |