Organization
BOULEVARD DIAGNOSTIC MGMT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES WALLER (OPERATIONS MANAGER)
(817) 741-0808
Entity
Organization
Contact information
Practice address
3120 W SOUTHLAKE BLVD # 140, SOUTHLAKE, TX 76092-6783
(817) 741-0808
(817) 741-0841
Mailing address
3120 W SOUTHLAKE BLVD # 140, SOUTHLAKE, TX 76092-6783
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
12/11/2012
Last updated
12/11/2012
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