| NPI | 1194123455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANN ANDRIA BROWELL Counselor 469-939-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TX 12506) |
| Additional Taxonomies | 251S00000X (Licence: TX 58527) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2014-12-18 |