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1386003259
ACTIVE HEALTH PHYSICAL MEDICINE, PLLC
BENBROOK, TX
NPI
1386003259
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Entity Type
Organization
Authorized Contact
ELIAS LARA
Sole Mbr
817-738-9777
Organization Subpart ?
No
Primary Taxonomy
208D00000X General Practice
Enumeration Date
2016-02-19
Last Update Date
2016-02-19
Business Address
ACTIVE HEALTH PHYSICAL MEDICINE, PLLC
6431 SOUTHWEST BLVD
BENBROOK, TX 76132-2777
Phone number: 817-738-9777
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Mailing Address
ACTIVE HEALTH PHYSICAL MEDICINE, PLLC
6431 SOUTHWEST BLVD
BENBROOK, TX 76132-2777
Phone number: 817-738-9777
Copy