| NPI | 1659805976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IBETT ROBLES Manager 713-530-0003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2017-04-13 |