| NPI | 1710159918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KESTER IREDIA OKPIABHELE Administrator 832-602-7471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2008-04-08 |