Individual
SUSAN BRADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2009 TREMONT AVE, FORT WORTH, TX 76107-3959
(817) 395-6284
(817) 423-7734
Mailing address
2009 TREMONT AVE, FORT WORTH, TX 76107-3959
(817) 395-6284
(817) 423-7734
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/10/2021
Last updated
06/10/2021
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