Individual
MR. JIM RUSS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 JOYCE CTR, NOTRE DAME, IN 46556-5678
(574) 631-3304
(574) 631-3305
Mailing address
113 JOYCE CTR, NOTRE DAME, IN 46556-5678
(574) 631-3304
(574) 631-3305
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000278A
IN
Other
Enumeration date
03/09/2006
Last updated
07/08/2007
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