| NPI | 1770023582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAILEY RAY Sole Proprietor 806-831-5529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 69003) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-02-27 |