Individual
MR. JEROME RICHARD MYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
8522 RICHARDSON KING RD, WAXHAW, NC 28173-8738
(704) 614-2823
Mailing address
PO BOX 402, WAXHAW, NC 28173-1046
(704) 614-2823
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
A7806
NC
Other
Enumeration date
05/04/2011
Last updated
06/13/2011
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