Organization
MANCHESTER INTERVENTIONAL PAIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY WALLS (PRESIDENT)
(972) 788-7500
Entity
Organization
Contact information
Practice address
1305 AIRPORT FWY, SUITE 103, BEDFORD, TX 76021-6605
(817) 571-2607
Mailing address
PO BOX 674032, DALLAS, TX 75267-4032
(972) 479-1115
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
04/29/2015
Last updated
04/20/2016
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