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1497009583
TACKETT CUSTOM MEDICINE
WEATHERFORD, TX
NPI
1497009583
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Entity Type
Organization
Authorized Contact
DAVID ROGER MORRIS
PIC
817-441-7046
Organization Subpart ?
No
Primary Taxonomy
261Q00000X Clinic/Center
(Licence: TX 28226)
Enumeration Date
2012-10-29
Last Update Date
2012-10-29
Business Address
TACKETT CUSTOM MEDICINE
175 COLLEGE PARK DR
WEATHERFORD, TX 76086-6211
Phone number: 817-550-6046
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Mailing Address
TACKETT CUSTOM MEDICINE
132 EL CHICO TRL
WILLOW PARK, TX 76087-8865
Phone number: 817-441-7046
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