| NPI | 1699164335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA LYN GRAMIGNA Lpc 325-232-3021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 17026) |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2015-01-19 |