| NPI | 1669797205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARAREH SALKHORDEH Owner 512-328-2015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 6347T) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2010-04-06 |