| NPI | 1619121308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY DOMINGER PERRY Pharmacy Technician 281-403-4474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: DE 4526529) |
| Enumeration Date | 2008-11-09 |
| Last Update Date | 2008-11-09 |