Individual
MRS. JESSICA M GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4703 HIGHWOOD DR, FORT WAYNE, IN 46815-6067
(260) 797-3604
Mailing address
4703 HIGHWOOD DR, FORT WAYNE, IN 46815-6067
(260) 797-3604
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
0501147343
IN
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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