NPI | 1487744900 |
---|---|
Entity Type | Organization |
Authorized Contact | DAVID DEAN LONG Owner 432-714-4650 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX H0574) |
Enumeration Date | 2006-10-13 |
Last Update Date | 2008-05-27 |