Individual
MS. MELISSA L BLAQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1016 I.C. KING RD., BROOKHAVEN RETREAT, SEYMOUR, TN 37865
(865) 573-3656
(865) 609-6216
Mailing address
1016 I.C. KING RD., BROOKHAVEN RETREAT, SEYMOUR, TN 37865
(865) 573-3656
(865) 609-6216
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/31/2007
Last updated
10/31/2007
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