| NPI | 1447404082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD WALLACE State Executive Director 512-343-8606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2008-11-10 |