Individual
ALONZO ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6110 HIGHWAY 18 W, JACKSON, MS 39209-9322
(601) 622-1808
Mailing address
PO BOX 75685, JACKSON, MS 39282-5685
(601) 622-1808
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/13/2015
Last updated
06/16/2015
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