| NPI | 1841488145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANA O WILSON Director Of Credentialing 409-730-2006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX J7414) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2012-12-27 |