Individual
ERICA Q TROUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 GREENLEAF RD, CONYERS, GA 30013-2279
(914) 439-0574
Mailing address
820 GREENLEAF RD, CONYERS, GA 30013-2279
(914) 439-0574
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
BLH-21441
GA
Other
Enumeration date
10/11/2017
Last updated
10/11/2017
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