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Individual

BRANDI BRIANNE BANNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT,CMMT,MTI

Contact information

Practice address
3706 MOCKINGBIRD LN, AMARILLO, TX 79109-3208
(806) 477-2111
Mailing address
4200 ARDEN RD, AMARILLO, TX 79110-4102
(806) 477-2111

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT102494
TX

Other

Enumeration date
06/05/2010
Last updated
06/05/2010
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