| NPI | 1699555110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE JACKSON CEO 214-865-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 247200000X |
| Additional Taxonomies | 261Q00000X |
| 305S00000X Point of Service | |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-17 |