Organization
GREAT SOUTHWEST MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA R GUITREAU (AGENT)
(214) 382-1909
Entity
Organization
Contact information
Practice address
643 S GREAT SOUTHWEST PKWY, SUITE 104, GRAND PRAIRIE, TX 75051-1056
(214) 363-5400
Mailing address
643 S GREAT SOUTHWEST PKWY, SUITE 104, GRAND PRAIRIE, TX 75051-1056
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
K0566
TX
Other
Enumeration date
07/18/2013
Last updated
07/18/2013
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