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Individual

MRS. KATHY L JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
15685 N IRON BRIDGE RD, MARSHALL, IL 62441-4663
(812) 241-6704
Mailing address
15685 N IRON BRIDGE RD, MARSHALL, IL 62441-4663
(812) 241-6704

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
J250-5125-9895
IL

Other

Enumeration date
08/30/2010
Last updated
08/30/2010
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