Stacey    King    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006605
Tax ID
262894831
Effective Date
4/1/2012
Last Updated
10/25/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1720 North First Street Suite A
Garland, TX 75040
United States
County
Dallas
Phone
2143641020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address