Individual
MR. JESSIE LEO WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
6272 E WINDSOR LN, NORCROSS, GA 30093-1363
(770) 934-5264
Mailing address
6272 E WINDSOR LN, NORCROSS, GA 30093-1363
(770) 934-5264
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT001245
GA
Other
Enumeration date
06/11/2007
Last updated
07/08/2007
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