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Individual

KHALEEL MOHAMMAD MOUSSA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
412 AMBERTON CT, ANTIOCH, TN 37013-5631
(615) 521-3962
Mailing address
412 AMBERTON CT, ANTIOCH, TN 37013-5631
(615) 521-3962

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
106760021
TN

Other

Enumeration date
02/22/2022
Last updated
02/25/2022
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