Individual
RAYTILLIA R. BALAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASTER BARBER & COSM
Contact information
Practice address
299 WATER CREST DR, BRUNSWICK, GA 31523-6108
(912) 290-9898
Mailing address
299 WATER CREST DR, BRUNSWICK, GA 31523-6108
(912) 290-9898
Taxonomy
Speciality
Code
Description
License number
State
173C00000X
Reflexologist
CO126396
GA
1744P3200X
Prosthetics Case Management
Primary
CO126396
GA
Other
Enumeration date
08/18/2015
Last updated
02/06/2016
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