Individual
THOMAS FOMUKONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2433 GOLDFINCH LN, GARLAND, TX 75042-8022
(972) 272-5820
Mailing address
2433 GOLDFINCH LN, GARLAND, TX 75042-8022
(972) 272-5820
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311971
TX
Other
Enumeration date
06/16/2014
Last updated
06/16/2014
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