Benjamin    Quiroz    DC
Contract Details
Facility name
Provider ID
P000006503
Tax ID
260750332
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4100 Bonham Ave
Odessa, TX 79762
United States
County
Ector
Phone
4323638182 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address