Individual
MRS. LUEWANA KIM JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4466 KIMMEL RD, COLUMBUS, OH 43224-1131
(614) 262-3559
Mailing address
4466 KIMMEL RD, COLUMBUS, OH 43224-1131
(614) 262-3559
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/14/2013
Last updated
07/31/2014
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