Organization
BOULEVARD DIAGNOSTIC MANAGEMENT GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES AUBREY WALLER (MANAGING MANAGER)
(817) 528-7044
Entity
Organization
Contact information
Practice address
3120 W SOUTHLAKE BLVD, SOUTHLAKE, TX 76092-6783
(817) 741-0808
Mailing address
3120 W SOUTHLAKE BLVD, SOUTHLAKE, TX 76092-6783
(817) 741-0808
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Enumeration date
12/19/2012
Last updated
12/19/2012
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