| NPI | 1780829812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE JEAN WATKINS President 817-929-5792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 101183) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2008-12-03 |