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1891363321
JOEL MICAH SUPPLE
SOUTHLAKE, TX
NPI
1891363321
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
208600000X Surgery
(Licence: TX 202123)
Enumeration Date
2021-06-11
Last Update Date
2021-07-21
Business Address
JOEL MICAH SUPPLE CSFA, CST
809 SILVERTON ST
SOUTHLAKE, TX 76092-3854
Phone number: 214-227-2457
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Mailing Address
JOEL MICAH SUPPLE CSFA, CST
PO BOX 938
ROWLETT, TX 75030-0938
Phone number: 214-227-2457
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