| NPI | 1851798425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA DALLAS Practice Administrator 832-237-4269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX l0096) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2014-11-26 |