Individual
MRS. JESSICA KHAMVONGSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2812 JASMINE CT, BEDFORD, TX 76021-2703
(817) 505-3488
Mailing address
2812 JASMINE CT, BEDFORD, TX 76021-2703
(817) 505-3488
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/04/2021
Last updated
03/04/2021
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