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Individual

MISS LUCIA KOON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
191 ROWLAND AVE, MANSFIELD, OH 44903-1444
(567) 303-9587
Mailing address
191 ROWLAND AVE, MANSFIELD, OH 44903-1444
(567) 303-9587

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
72546356
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2907724
OH
05
2958876
OH
Enumeration date
12/21/2009
Last updated
12/21/2009
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