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1043218720
CHARLES MARK RUSSELL
SAN ANTONIO, TX
NPI
1043218720
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: TX Pa00353)
Enumeration Date
2005-07-07
Last Update Date
2016-10-18
Business Address
-- CHARLES MARK RUSSELL PA
6157 NW LOOP 410 STE. 124
SAN ANTONIO, TX 78238-3302
Phone number: 210-523-1411
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Mailing Address
-- CHARLES MARK RUSSELL PA
6157 NW LOOP 410 STE. 124
SAN ANTONIO, TX 78238-3302
Phone number: 210-523-1411
Copy
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