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Organization

GULF SOUTH LITHOTRIPSY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THERESA DAVIS (DIRRECTOR, CBO)
(512) 314-4331
Entity
Organization

Contact information

Practice address
9825 SPECTRUM DR, BLDG 3, AUSTIN, TX 78717-4930
(512) 314-4331
Mailing address
PO BOX 847324, DALLAS, TX 75284-7324

Taxonomy

Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
Primary

Other

Enumeration date
11/05/2008
Last updated
11/05/2008
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