| NPI | 1477713584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BABATUNDE OLANREWAJU ADEDIGBA Manager 817-522-4432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |