Organization
SOUTH TEXAS LICE CLINICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY COPELAND (OWNER)
(210) 409-4635
Entity
Organization
Contact information
Practice address
6391 DE ZAVALA RD STE 222, SAN ANTONIO, TX 78249-2159
(210) 409-4635
Mailing address
6391 DE ZAVALA RD STE 222, SAN ANTONIO, TX 78249-2159
(210) 409-4635
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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