Individual
DOMINIQUE MICHELE WATERBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5400 EUPER LN, FORT SMITH, AR 72903-3232
(479) 755-6601
Mailing address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-3600
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
928984961
AR
Other
Enumeration date
04/09/2019
Last updated
04/09/2019
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