| NPI | 1811273642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS MAE GORDON Program Manager (Owner) 214-808-6070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |