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1114453933
KEITH ANTHONY CLARK
DALLAS, TX
NPI
1114453933
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225700000X Massage Therapist
(Licence: TX MT111749)
Enumeration Date
2017-05-11
Last Update Date
2017-05-11
Business Address
-- KEITH ANTHONY CLARK
11311 N CENTRAL EXPY STE 211
DALLAS, TX 75243-6707
Phone number: 214-315-2959
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Mailing Address
-- KEITH ANTHONY CLARK
PO BOX 273326
FORT COLLINS, CO 80527-3326
Phone number: 866-996-2772
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