Andrea    Wilson    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003730
NPI
1063467678
Tax ID
742938801
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
133 West Water Street
Kerrville, TX 78028
United States
County
Kerr
Phone
8308962273 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address