Individual
MR. JACK GEORGE RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
540 COLLEGE AVE, MEDFORD, WI 54451-2027
(715) 748-3332
(715) 748-3342
Mailing address
540 COLLEGE AVE, MEDFORD, WI 54451-2027
(715) 748-3332
(715) 748-3342
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2651-125
WI
Other
Enumeration date
02/25/2008
Last updated
03/13/2008
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