Individual
LARINA DEIRELAND MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6375 CAPITOL KNL, FAIRBURN, GA 30213-4430
(414) 803-7188
Mailing address
6375 CAPITOL KNL, FAIRBURN, GA 30213-4430
(414) 803-7188
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT011474
GA
Other
Enumeration date
09/09/2020
Last updated
10/25/2020
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