Organization
SUPERIOR GRACE ENTERPRISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH MOORE LSA (OWNER)
(214) 886-9766
Entity
Organization
Contact information
Practice address
2005 BISHOP DR, FORNEY, TX 75126-4058
(214) 886-9766
Mailing address
2005 BISHOP DR, FORNEY, TX 75126-4058
(214) 886-9766
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00597
TX
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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