Organization
GENUINE QUEENS JCL CARE
Active
Other names
GENUINE QUEENA JCL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LKIENDRIA TRISCHUAN JOHNSON (OWNER)
(210) 649-5653
Entity
Organization
Contact information
Practice address
3730 S LOOP 1604 E, SAN ANTONIO, TX 78264-9551
(210) 649-5653
Mailing address
PO BOX 10306, SAN ANTONIO, TX 78210-0306
(210) 649-5653
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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