Individual
HOLLY VALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA
Contact information
Practice address
4780 N JOSEY LN, CARROLLTON, TX 75010-4615
(972) 395-2210
Mailing address
2304 CORTELLIA ST, PLANO, TX 75074-0296
(940) 395-6484
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00777
TX
Other
Enumeration date
09/13/2018
Last updated
11/01/2019
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