NPI | 1184973216 |
---|---|
Entity Type | Organization |
Authorized Contact | TAMI TERESE DITTBURNER Provider/Owner 956-428-8264 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 520212) |
Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: TX 520212) |
Enumeration Date | 2012-09-05 |
Last Update Date | 2013-11-20 |