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1023867546
ITASCA HEALING MEDICAL PRACTICE
NACOGDOCHES, TX
NPI
1023867546
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Entity Type
Organization
Authorized Contact
SUZANNA ITASCA FULLER
Owner
936-250-2062
Organization Subpart ?
No
Primary Taxonomy
207Q00000X Family Medicine
Enumeration Date
2024-05-16
Last Update Date
2024-10-02
Business Address
ITASCA HEALING MEDICAL PRACTICE
223 KING ST
NACOGDOCHES, TX 75961-4421
Phone number: 936-622-0552
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Mailing Address
ITASCA HEALING MEDICAL PRACTICE
223 KING ST
NACOGDOCHES, TX 75961-4421
Phone number: 936-622-0552
Copy
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