| NPI | 1629270590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL MICHAEL Owner 210-260-5509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 001007897) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |