Individual
JACOB WALTON-CONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13 JAIME LN, CLARKSVILLE, AR 72830-2005
(479) 774-9049
Mailing address
13 JAIME LN, CLARKSVILLE, AR 72830-2005
(479) 774-9049
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
636
AR
Other
Enumeration date
03/04/2016
Last updated
03/04/2016
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