Organization
FIRST SOURCE WOUND CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER BROKISH MD (VICE-PRESIDENT)
(469) 850-3114
Entity
Organization
Contact information
Practice address
1540 KELLER PKWY STE 108-168, KELLER, TX 76248-3686
(469) 850-3114
Mailing address
1540 KELLER PKWY STE 108-168, KELLER, TX 76248-3686
(469) 850-3114
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
03/13/2024
Last updated
03/13/2024
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