Individual
ANITA WILCOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6009 SHELTON ST, FORT WORTH, TX 76112-3934
(817) 253-0742
Mailing address
11200 PLEASANT WOOD LN, FORT WORTH, TX 76140-6538
(817) 253-0742
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/06/2012
Last updated
02/27/2012
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