| NPI | 1366705196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON CANNON Provider Network Menager 214-689-8060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: PA spo11304) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2012-06-18 |