| NPI | 1962827758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA FLORES Office Manager 817-496-2343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 24570) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2014-03-03 |