| NPI | 1780193045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LITA MICHELE WILLIS Owner/Senior Service Representative 281-753-6936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX B566406) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2017-09-29 |