| NPI | 1255419404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA P RICKS Credentialling COO Rdinator 903-465-1857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX L8985) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |