| NPI | 1689095291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE A MAYES Office Manager 281-330-8519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX G1935) |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2013-12-27 |