Individual
TONYA RANDOLPH SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12227 W HADLEY ST, AVONDALE, AZ 85323-8434
(414) 617-8549
Mailing address
12227 W HADLEY ST, AVONDALE, AZ 85323-8434
(414) 617-8549
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
3467447
AZ
Other
Enumeration date
12/09/2013
Last updated
12/09/2013
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