Individual
MR. KEITH AUSTIN WOMMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.S.B.
Contact information
Practice address
514 RONSON DR, CORPUS CHRISTI, TX 78412-3152
(361) 992-2487
(361) 991-6310
Mailing address
514 RONSON DR, CORPUS CHRISTI, TX 78412-3152
(361) 992-2487
(361) 991-6310
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Enumeration date
02/17/2012
Last updated
02/17/2012
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