Individual
TARA L BURKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2425 E SOUTHLAKE BLVD, #100, SOUTHLAKE, TX 76092-6674
(817) 442-0222
(817) 442-0223
Mailing address
2425 E SOUTHLAKE BLVD, #100, SOUTHLAKE, TX 76092-6674
(817) 442-0222
(817) 442-0223
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
109811
TX
Other
Enumeration date
11/06/2012
Last updated
11/06/2012
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