| NPI | 1437518248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICAH MULLICAN Director 469-222-0009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 10598) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |