Individual
OCTAVIA LYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1405 MARENA MOORE CT, DALLAS, TX 75232-6620
(469) 410-9145
Mailing address
1405 MARENA MOORE CT, DALLAS, TX 75232-6620
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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