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2100 S Mobberly Ave Longview TX 75602-3564 | |
(903) 233-4110 | |
(972) 367-3451 |
Full Name | |
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Speciality | Family Medicine |
Location | 2100 S Mobberly Ave, Longview, Texas |
Authorized Official Name and Position | Mouzon Bass (AGENT) |
Authorized Official Contact | 8089566505 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5050 Spring Valley Rd Dallas TX 75244-3995 Ph: (800) 555-9073 | 2100 S Mobberly Ave Longview TX 75602-3564 Ph: (903) 233-4110 |
NPI Number | 1750774030 |
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Provider Enumeration Date | 03/11/2015 |
Last Update Date | 03/11/2015 |
Identifier | Type | State | Issuer |
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1750774030 | NPI | - | NPPES |
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