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Organization
SELECT ASC DEVELOPERS OF SOUTHLAKE, LLC
Active
Organization
SELECT ASC DEVELOPERS OF SOUTHLAKE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY WALLS (PRESIDENT)
(972) 234-4740
Entity
Organization
Contact information
Practice address
3065 W SOUTHLAKE BLVD, SOUTHLAKE, TX 76092-6730
(972) 234-4740
Mailing address
PO BOX 674201, DALLAS, TX 75267-4201
(972) 234-4740
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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