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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