| NPI | 1801010483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOLORES ANN RAIVZEE-BELL Program Manager 214-330-2403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-08-22 |