Individual
SU-SAN CANNON SPAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1712 WURZBURG DR, FORT WORTH, TX 76134-3320
(817) 476-1510
Mailing address
PO BOX 16741, FORT WORTH, TX 76162-0741
(817) 476-1510
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
TX
Other
Enumeration date
08/17/2020
Last updated
08/19/2020
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