| NPI | 1619354693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL D STARK Financial Coordinator 936-539-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 16499) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |