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Individual

MR. RICHARD C BOLEWARE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CP

Contact information

Practice address
2 OLD RIVER PL STE D, JACKSON, MS 39202-3435
(601) 944-1130
(601) 355-7476
Mailing address
2 OLD RIVER PL STE D, JACKSON, MS 39202-3435
(601) 944-1130
(601) 355-7476

Taxonomy

Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CP003226
MS

Other

Enumeration date
12/27/2007
Last updated
05/19/2015
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