| NPI | 1386194926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | L B BRYANT Counselor 832-473-1377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |