Individual
JUANITA YVETTE MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 CANARY LN, DESOTO, TX 75115-7110
(214) 457-4062
(469) 297-4222
Mailing address
500 CANARY LN, DESOTO, TX 75115-7110
(214) 457-4062
(469) 297-4222
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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