Individual
MISS MIRANDA ELISE COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 FAIRMOUNT AVE, FORT WORTH, TX 76110-1324
(940) 799-7922
Mailing address
1717 FAIRMOUNT AVE, FORT WORTH, TX 76110-1324
(940) 799-7922
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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