| NPI | 1639520653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO M. BONNOR President 281-579-5638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX L5679) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2016-06-30 |