PROVISIONCARE MEDICAL

HUMBLE, TX
NPI1144884826
Doing Business AsMANCAVEMD
Entity TypeOrganization
Authorized ContactDERRICK TRAYLOR
CEO
503-901-5733
Organization Subpart ?No
Primary Taxonomy207Q00000X Family Medicine
Enumeration Date2019-04-28
Last Update Date2019-06-11
Business Address
PROVISIONCARE MEDICAL
11501 N SAM HOUSTON PKWY E STE A
HUMBLE, TX 77396-4635
Phone number: 281-652-5612
Mailing Address
PROVISIONCARE MEDICAL
14700 WOODSON PARK DR APT 1512
HOUSTON, TX 77044-4531
Phone number: 281-652-5612
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