| NPI | 1457646705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES NIELSEN Owner 903-712-4440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 1223G0001x) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2011-06-15 |