Organization
GSWIZZ LADIES WORKOUT EXPRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SYLVIA PATRICIA BURRELL (OWNER)
(512) 272-9792
Entity
Organization
Contact information
Practice address
13419 US HIGHWAY 290 E, BLDG # 7, MANOR, TX 78653-4589
(512) 272-9792
Mailing address
13419 US HIGHWAY 290 E, BLDG # 7, MANOR, TX 78653-4589
(512) 272-9792
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
20070218
TX
Other
Enumeration date
01/07/2008
Last updated
06/26/2008
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