| NPI | 1295271013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA L COLVIN Manager 903-872-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 15110) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-01-18 |