GRACE SOUTHERN MEDICAL CLINIC, PLLC
Ambulatory Health at Samuell Blvd, Dallas, TX

License number
Texas P4031
Category
Ambulatory Health
Type
Primary Care
Owner
Name: SERGIO CALIXTO-MONTANEZ M.D.
Title: MEMBER
Phone: (214) 381-1910
Address
Address
6300 Samuell Blvd STE. 120, Dallas, TX 75228
National Provider ID: 1821486358
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about GRACE SOUTHERN MEDICAL CLINIC, PLLC at bizstanding.com

GRACE SOUTHERN MEDICAL CLINIC, PLLC

6300 Samuell Blvd STE 120, Dallas, TX 75228

Status:
Inactive
Registration:
Nov 13, 2014
State ID:
0802100906
Business type:
Domestic Limited Liability Company (LLC)
Member:
Sergio Calixto-Montanez (Member)
Agent:
Sergio Calixto-Montanez,6300 Samuell Blvd STE 120, Dallas, TX 75228 (Physical)
TIN:
32055668514

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