Individual
MRS. SHARON RUTH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 N. HWY 360, SUITE 1704, GRAND PRAIRIE, TX 75050-1062
(972) 206-0111
(972) 206-0111
Mailing address
4801 LAKESHORE CT, COLLEYVILLE, TX 76034-2828
(972) 206-0111
(972) 206-0111
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0058191
TX
Other
Enumeration date
10/17/2006
Last updated
07/09/2007
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