Individual
LORI JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3103 S DARTMOUTH ST, DETROIT, MI 48217-1020
(313) 739-4339
Mailing address
3103 S DARTMOUTH ST, DETROIT, MI 48217-1020
(313) 739-4339
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
J250546227628
MI
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
08/12/2009
Last updated
08/12/2009
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