Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2018-02-05
- Last updated
- 2022-09-21
Licenses
- License TX
- 31762
Location
- Practice location
- 485 S ROBB ST., STE B
- City
- TRINITY TX
- Postal code
- 75862
- Phone
- 936-594-3593
Organization contact
- Name
- KRISTI KUBOSH
- Title
- Owner
- Phone
- 7972184735
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.