Individual
JAIS MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 S LINCOLN AVE, LEBANON, PA 17042-7165
(717) 383-1780
Mailing address
1000 S LINCOLN AVE, LEBANON, PA 17042-7165
(717) 383-1780
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG012653
PA
Other
Enumeration date
10/27/2018
Last updated
10/27/2018
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