| NPI | 1548547771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILE KETTLE Officer 281-419-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: KS G3078) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2011-11-16 |