Individual
S DOMINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4112 HUGHES LEA, TUCKER, GA 30084-1101
(770) 827-2009
Mailing address
4112 HUGHES LEA, TUCKER, GA 30084-1101
(770) 938-5667
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT005793
GA
Other
Enumeration date
03/01/2010
Last updated
03/01/2010
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