Individual
EDMON JONH MORENO HILARIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 MITCHELL STREET, HUMBOLDT, TN 38343
(731) 784-5183
(731) 784-2105
Mailing address
2400 MITCHELL STREET, HUMBOLDT, TN 38343
(731) 784-5183
(731) 784-2105
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4301
TN
Other
Enumeration date
08/09/2010
Last updated
08/09/2010
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