| NPI | 1669832366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER BOWMAN Owner 972-955-4013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 13142) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-02-24 |