| NPI | 1538561675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA WHITE Manager 214-853-1686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 137354) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2014-09-19 |