| NPI | 1932460318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAHNAAZ NISTAR Director 210-349-3715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 24242) |
| Enumeration Date | 2012-06-02 |
| Last Update Date | 2012-06-02 |