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14001 Shadow Glen Blvd Suite G Manor TX 78653-3386 | |
(512) 535-4787 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 14001 Shadow Glen Blvd, Manor, Texas |
Authorized Official Name and Position | Marilyn Ruiz (MEMBER) |
Authorized Official Contact | 5125354787 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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14001 Shadow Glen Blvd Suite G Manor TX 78653-3386 Ph: (512) 535-4787 | 14001 Shadow Glen Blvd Suite G Manor TX 78653-3386 Ph: (512) 535-4787 |
NPI Number | 1154761559 |
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Provider Enumeration Date | 06/28/2013 |
Last Update Date | 06/28/2013 |
Identifier | Type | State | Issuer |
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1154761559 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | N0419 (Texas) | Primary |