| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 2403 E Waco Dr, Waco, Texas |
| Authorized Official Name and Position | Krista Stone (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 2547727037 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4800 Lakewood Dr Ste 5 Waco TX 76710-2965 Ph: (254) 772-7037 | 2403 E Waco Dr Waco TX 76705-3259 Ph: (254) 799-5190 |
| NPI Number | 1588868004 |
|---|---|
| Provider Enumeration Date | 06/11/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588868004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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