Individual
TIA KINGCANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3662 W CAMP WISDOM RD, DALLAS, TX 75237-2500
(469) 535-1965
Mailing address
2633 MCKINNEY AVE # 130124, DALLAS, TX 75204-2581
(469) 535-1965
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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