| NPI | 1609069434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSON JON KRUGMAN Owner 512-401-2008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 9080) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2012-02-06 |