Individual
CORY FAIRCHILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7510 E ONZA AVE, MESA, AZ 85212-9747
(480) 203-7684
Mailing address
7510 E ONZA AVE, MESA, AZ 85212-9747
(480) 203-7684
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-17781
AZ
Other
Enumeration date
01/11/2016
Last updated
01/11/2016
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