| NPI | 1144432642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERCEDES M. HYSAW Owner Director 210-797-8812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TX 010166) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |