Organization
SUMMIT AVENUE PAIN CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TED GROSBECK (MANAGER)
(469) 362-6909
Entity
Organization
Contact information
Practice address
1201 SUMMIT AVE, SUITE 400, FORT WORTH, TX 76102-4413
(972) 234-4740
(972) 231-7095
Mailing address
PO BOX 674210, DALLAS, TX 75267-4210
(972) 234-4740
(972) 231-7095
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2010
Last updated
10/18/2010
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