| NPI | 1942682737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT BRYAN Owner/Operator 210-551-8244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 10715) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2015-06-29 |