Individual
PRECIOUS LAQUON BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1450 N STATE HIGHWAY 360 APT 371, GRAND PRAIRIE, TX 75050-4108
(262) 751-0253
Mailing address
1450 N STATE HIGHWAY 360 APT 371, GRAND PRAIRIE, TX 75050-4108
(262) 751-0253
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
45590009
TX
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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