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Individual

GENELA GISSEL VALLEJO DE PETER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
140 ROSCOMMON CT, TYRONE, GA 30290-1879
(470) 776-4223
Mailing address
140 ROSCOMMON CT, TYRONE, GA 30290-1879
(470) 776-4223

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
GA

Other

Enumeration date
04/06/2018
Last updated
04/06/2018
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