| NPI | 1417313222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN TITTLE Owner 214-905-5075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX F7235) |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2016-01-08 |