| NPI | 1861893760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN L RAY Owner 214-396-7725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX N6605) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2014-09-10 |