| NPI | 1396125118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRODERICK MONDY Manager 214-234-8444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 25694) |
| Enumeration Date | 2015-06-06 |
| Last Update Date | 2015-06-06 |