| NPI | 1992058259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENT ROZACKY Owner 512-446-5844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX 11594) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2012-10-23 |