Bravo Iom LLC

NPI #1003372285 in Ft Worth, Texas

Provider Information

NPI Number
1003372285
Entity Type
Organization
Organization Name
Bravo Iom LLC
Primary Specialty
Electrodiagnostic Medicine
Enumeration Date
Feb 13, 2019
Last Updated
Feb 13, 2019

Practice Location

Address
111 BOLAND ST STE 211
State
Texas
ZIP Code
76107-1265
Phone
(817) 529-8488

Authorized Official

Name
GINA SULLLIVAN
Title
BILLING MANAGER
Phone
(817) 528-8488

Specialties & Taxonomy Codes

Specialty
Electrodiagnostic Medicine

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