Individual
BETSY CUSTARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3484 N CONSTANCE DR., PRESCOTT VALLEY, AZ 86314
(928) 443-1991
Mailing address
440 N WASHINGTON AVE, PRESCOTT, AZ 86301-2642
(928) 443-1991
(928) 771-2351
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
12586
AZ
Other
Enumeration date
04/21/2009
Last updated
04/21/2009
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