| NPI | 1942576301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCHANTEL LETICIA DUNN Program Director 832-797-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 02762050) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-03-29 |