| NPI | 1164725545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAIN HANNAGAN Administrator 915-855-3363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX 1159340) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 3112) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2015-01-28 |