Organization
PURE SURGICAL ASSISTANT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. QIJUN SONG LSA, SA-C (MANAGER)
(713) 234-0081
Entity
Organization
Contact information
Practice address
475 BENDWOOD DR, HOUSTON, TX 77024-8813
(281) 409-3854
(832) 201-7900
Mailing address
PO BOX 79576, HOUSTON, TX 77279-9576
(713) 234-0081
(832) 201-7900
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00504
TX
Other
Enumeration date
08/21/2014
Last updated
09/10/2014
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