Individual
WILLIAM CLARK0
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8921 BLACK PANTHER CV, HERNANDO, MS 38632-4305
(901) 590-5968
Mailing address
8921 BLACK PANTHER CV, HERNANDO, MS 38632-4305
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
08/19/2009
Last updated
08/19/2009
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