| NPI | 1730257429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLON B JACKSON Credentials Manager 210-292-6707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX F2298) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-08-22 |