| NPI | 1679609119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JOSEPH BENAVIDES Owner 210-522-9732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 119321) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-08-22 |