Organization
BATB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACIE WILSON (PRACTICE MANAGER)
(972) 649-5480
Entity
Organization
Contact information
Practice address
1256 W EXCHANGE PKWY STE 200, ALLEN, TX 75013-7049
(972) 649-5480
(469) 854-6664
Mailing address
1256 W EXCHANGE PKWY STE 200, ALLEN, TX 75013-7049
(972) 649-5480
(469) 854-6664
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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