Individual
KAHLIR DABRIL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1425 S 52ND ST, PHILADELPHIA, PA 19143-5006
(267) 608-6335
Mailing address
1425 S 52ND ST, PHILADELPHIA, PA 19143-5006
(267) 608-6335
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
31508228
PA
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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