Individual
JACK LAWRENCE MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7620 N HARTMAN LN STE 184, TUCSON, AZ 85743-7485
(520) 668-6306
Mailing address
8936 N ONYX ST, TUCSON, AZ 85742-9415
(520) 668-6306
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-13827
AZ
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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