Organization
POET'S GLADE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD CHRISTOPHER CARROLL MDIV (DIRECTOR)
(832) 622-3766
Entity
Organization
Contact information
Practice address
18065 RIO HONDO DR, BUENA VISTA, CO 81211-9126
(832) 622-3766
Mailing address
PO BOX 875, BUENA VISTA, CO 81211-0875
(832) 622-3766
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
32043043572
TX
Other
Enumeration date
06/26/2011
Last updated
06/26/2011
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