| NPI | 1164816179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY W HUBBARD Manager 214-528-3770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 15507) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2020-03-09 |