Organization
FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TOBEY R MCCRORY (PROGRAM MANAGER)
(682) 234-9152
Entity
Organization
Contact information
Practice address
874 THOMAS CROSSING DR, BURLESON, TX 76028-3206
(682) 234-9152
Mailing address
874 THOMAS CROSSING DR, BURLESON, TX 76028-3206
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
TX
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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