Individual
CHARLENE MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 SCENIC DR, MODESTO, CA 95350-6131
(209) 525-6150
Mailing address
800 SCENIC DR, MODESTO, CA 95350-6131
(209) 525-6150
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Enumeration date
10/24/2007
Last updated
11/06/2012
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