Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Sep 22, 2013
License(s)
707025 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 101 REDWATER RD APT 257 | Wake Village, TX 75501-5746 | 903-794-7874 |
| LOCATION | 5503 N STATELINE AVE | Texarkana, TX 75503-5303 | 903-794-7874 |
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