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Organization
RIVERSIDE INTERVENTIONAL PAIN CENTER LLC
Active
Organization
RIVERSIDE INTERVENTIONAL PAIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY WALLS (PRESIDENT)
(972) 234-4740
Entity
Organization
Contact information
Practice address
1778 N PLANO RD, SUITE 300B, RICHARDSON, TX 75081-1968
(972) 231-9770
(972) 231-9761
Mailing address
PO BOX 674102, DALLAS, TX 75267-4102
(972) 479-1115
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
03/27/2015
Last updated
04/20/2016
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