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Organization

FOUNTAIN OF LIFE LLC

Active
Other names
Medcuba clinic
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CYNTHIA DIANE GOODMAN (DR)
(832) 548-1701
Entity
Organization

Contact information

Practice address
1820 W 43RD ST, HOUSTON, TX 77018-3006
(832) 548-1701
(713) 393-7466
Mailing address
1820 W 43RD ST, HOUSTON, TX 77018-3006
(832) 548-1701
(713) 393-7466

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary

Other

Enumeration date
12/26/2012
Last updated
07/30/2013
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