Ralph    Kinney    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005950
Tax ID
582529505
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3206 Peach Orchard Road
Augusta, GA 30906
United States
County
Richmond
Phone
8034410025 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address