Individual
MARK RAYMOND GRUESBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
24 WILLIE MAYS PLZ, SAN FRANCISCO, CA 94107-2134
(415) 972-1633
Mailing address
8829 E FAIRBROOK ST, MESA, AZ 85207-5117
(480) 986-4620
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0660
AZ
Other
Enumeration date
12/23/2006
Last updated
07/08/2007
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