Individual
MR. TERRY K DOUGLAS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 MILLBRIDGE RD, CLEMENTON, NJ 08021-5519
(856) 619-6121
Mailing address
124 MILLBRIDGE RD, CLEMENTON, NJ 08021-5519
(856) 619-6121
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
2596292
NJ
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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