Individual
MARA ELIZABETH BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
362 CATALPA AVE, HARROGATE, TN 37752-8149
(423) 869-9923
Mailing address
1206 NELL ST, TAZEWELL, TN 37879-4312
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2088
TN
Other
Enumeration date
07/23/2017
Last updated
07/23/2017
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