| NPI | 1356797484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON REITAN Self 817-637-4425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: WA CO 60629779) |
| Enumeration Date | 2016-05-07 |
| Last Update Date | 2016-05-07 |