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Organization
FOUR SEASONS BREAST FOUNDATION
Active
Organization
FOUR SEASONS BREAST FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE M ICENOGLE M.D. (PRESIDENT)
(210) 918-8510
Entity
Organization
Contact information
Practice address
4400 S PIEDRAS DR STE 200, SAN ANTONIO, TX 78228-1223
(210) 918-8510
Mailing address
PO BOX 100840, SAN ANTONIO, TX 78201-8840
(210) 918-8510
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
—
—
Other
Enumeration date
04/11/2008
Last updated
04/11/2008
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