| NPI | 1396183695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL LEE PENNELL Owner 214-549-7009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: TX 11401) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: TX 11401) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2013-06-07 |