Individual
SOMOVA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6316 FOREST KNOLL TRL, DALLAS, TX 75232-3110
(469) 387-9761
Mailing address
7008 WOODWICK DR, DALLAS, TX 75232-3534
(469) 387-9761
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
141051
TX
Other
Enumeration date
12/30/2015
Last updated
12/30/2015
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