Individual
IBRAHIM AZRAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3120 SHADY TREE LN, ANTIOCH, TN 37013-2482
(615) 585-3778
(206) 888-4011
Mailing address
3120 SHADY TREE LN, ANTIOCH, TN 37013-2482
(615) 585-3778
(206) 888-4011
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
189601
TN
Other
Enumeration date
10/19/2015
Last updated
10/19/2015
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