| NPI | 1326587767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD ALLEN WILSON Owner/President 936-756-9015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TX 26065) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |