| NPI | 1316307275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE MANZI Owner 346-308-6741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TX N7457) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: TX N7457) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2024-05-29 |