| NPI | 1669627410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD M. ELSNER President 817-657-5910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 10640) |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2008-11-20 |