Individual
GAIUS B FOMUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
203 LORIENT DR, MANSFIELD, TX 76063-5572
(214) 256-6648
Mailing address
203 LORIENT DR, MANSFIELD, TX 76063-5572
(214) 256-6648
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/25/2012
Last updated
10/25/2012
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