| NPI | 1760618706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDUARDO MARIO WILKINSON Partner 972-498-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX H3144) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: TX J3937) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2009-06-04 |