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Individual

DEDRA MATOYA ROBERTSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
110 BEASLEY ST, ANDALUSIA, AL 36420-4957
(334) 892-3784
Mailing address
110 BEASLEY ST, ANDALUSIA, AL 36420-4957
(334) 892-3784

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
23190424
AL

Other

Enumeration date
04/02/2019
Last updated
04/02/2019
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