| NPI | 1265777833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATANYA ANNETTA TAYLOR Owner 512-689-5880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 18932825) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2012-12-07 |