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1164669974
SHATORYA ANN MODKINS
DALLAS, TX
NPI
1164669974
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Entity Type
Organization
Authorized Contact
SHATORYA ANN MODKINS
CEO
214-208-6402
Organization Subpart ?
No
Primary Taxonomy
305R00000X Preferred Provider Organization
Enumeration Date
2009-01-15
Last Update Date
2009-01-15
Business Address
SHATORYA ANN MODKINS
4342 LASHLEY DR
DALLAS, TX 75232-1186
Phone number: 214-208-6402
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Mailing Address
SHATORYA ANN MODKINS
4342 LASHLEY DR
DALLAS, TX 75232-1186
Phone number: 214-208-6402
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