| NPI | 1528354701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYCIA ELAINE FRAZIER Program Manager 832-858-1245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2011-06-25 |
| Last Update Date | 2011-06-25 |