| NPI | 1336023399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN ADRIA PODINA Managing Partner 972-533-0490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-08-04 |