Organization
SLAROD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON A WILLIAMS MD (OWNER)
(214) 462-7887
Entity
Organization
Contact information
Practice address
546 E SANDY LAKE RD, 100, COPPELL, TX 75019-5786
(214) 462-7887
Mailing address
1365 FM 740 S, FORNEY, TX 75126-5342
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
M0969
TX
Other
Enumeration date
07/23/2012
Last updated
07/23/2012
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