Individual
CELESTIAL MARIE RANDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2312 WYATT CT, FORT WORTH, TX 76119-3104
(817) 907-2899
Mailing address
2312 WYATT CT, FORT WORTH, TX 76119-3104
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/27/2017
Last updated
10/27/2017
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