Individual
MR. JERRY LEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.H.S.
Contact information
Practice address
112 N BROAD ST, RM 821, PHILA, PA 19102-1510
(215) 568-0860
(215) 568-0769
Mailing address
6913 LIMEKILN PIKE, PHILADELPHIA, PA 19138-2007
(215) 548-1308
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/07/2007
Last updated
11/07/2007
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