Organization
SOUTHWEST SPINE WAVES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA SULLIVAN (BILLING MANAGER)
(817) 529-8488
Entity
Organization
Contact information
Practice address
111 BOLAND ST STE 211, FT WORTH, TX 76107-1265
(817) 529-8488
(903) 328-6568
Mailing address
111 BOLAND ST STE 211, FT WORTH, TX 76107-1265
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
11/12/2019
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