Organization
EXECUTIVE DE-TAILS
Active
Other names
Executive De-Tails
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK AIDELOJIE (CONSULTANT)
(817) 274-2284
Entity
Organization
Contact information
Practice address
2952 CELIAN DR, GRAND PRAIRIE, TX 75052-8737
(817) 247-5267
Mailing address
2952 CELIAN DR, GRAND PRAIRIE, TX 75052-8737
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
12/28/2006
Last updated
08/22/2020
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