Organization
PINE INTERVENTIONAL PROCEDURE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY WALLS (MANAGER)
(972) 234-4140
Entity
Organization
Contact information
Practice address
17051 DALLAS PKWY, STE 100, ADDISON, TX 75001-7101
(469) 916-0521
(972) 243-0212
Mailing address
PO BOX 268989, OKLAHOMA CITY, OK 73126-8989
(972) 479-1115
(972) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
10/01/2010
Last updated
10/02/2013
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