| NPI | 1295272524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN CARLIN Owner 281-893-0821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 30865) |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2017-01-25 |