| NPI | 1518557602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY HAYNES Billing And Credentialing Specialis 210-207-8689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2021-01-22 |