| NPI | 1952502551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES N AMAKO Program Director 281-630-4208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 001007657) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-08-22 |