| NPI | 1689891285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD CAMERON KIEFER Licensed Athletic Trainer 972-617-2075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: TX AT1418) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-06-25 |