| NPI | 1316200686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCHAYLITE R SIBLEY Owner 214-986-7462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 34293) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2012-06-20 |