| NPI | 1811274053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT SHANNON HUNERYAGER Secretary 214-727-7533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TX 132634) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |