| NPI | 1831560572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN E THOMAS Administrator 747-888-3678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 197607186) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |