| NPI | 1740511336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON GEROIANNI Executive Director 210-877-2228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 17053267341058) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2012-01-23 |