| NPI | 1841749033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHBY SIMONS Owner 318-366-0790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 74873) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |