PEDIAQ LLC
Ambulatory Health at Walpole Ln, Austin, TX

License number
Texas AP81285
Category
Ambulatory Health
Type
Primary Care
Owner
Name: DR. FRED JOHNSON DO
Title: MEDICAL DIRECTOR
Phone: (214) 984-3900
Address
Address 2
10413 Walpole Ln, Austin, TX 78739
4849 Greenville Ave STE 1225, Dallas, TX 75206
National Provider ID: 1255885745
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about PEDIAQ LLC at bizstanding.com

PEDIAQ LLC

4504 Mockingbird Ln, Dallas, TX 75205

Doing business as:
Pediaq LLC
Registration:
Mar 5, 2015
State ID:
0802174550
Business type:
Domestic Limited Liability Company (LLC)
Manager:
Jonathan O'sullivan (Manager)
TIN:
32055126265

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