| NPI | 1386196061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAUL DOMINGUEZ Alternate Administrator 956-775-5824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2016-10-28 |