Individual
JALISA MILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
629 BROADWAY CMNS, 704, GARLAND, TX 75043-5871
(214) 448-9475
Mailing address
629 BROADWAY CMNS, 704, GARLAND, TX 75043-5871
(214) 448-9475
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
05/30/2016
Last updated
05/30/2016
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