Individual
MS. KRISTIN ELIZABETH BOURQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1400 COLEMAN AVE, MERCER UNIVERSITY ATHLETIC DEPARTMENT, MACON, GA 31207-0001
(443) 745-3741
Mailing address
1400 COLEMAN AVE, MERCER UNIVERSITY ATHLETIC DEPARTMENT, MACON, GA 31207-0001
(443) 745-3741
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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