| NPI | 1831639947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA FARMER Member 682-320-7485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 13349) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |