| NPI | 1902108087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH J MAY-ADEYINKA Program Director 832-881-0782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2013-01-08 |