Individual
CHARLENE RENE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18029 STEPHENS DR, EASTPOINTE, MI 48021-1810
(586) 209-9161
Mailing address
18029 STEPHENS DR, EASTPOINTE, MI 48021-1810
(586) 209-9161
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/14/2016
Last updated
10/14/2016
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