Individual
MR. JESSE D IRWIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1000 W 10TH ST, ROLLA, MO 65401-2905
(573) 230-6703
Mailing address
1701 ASHWOOD DR, APARTMENT 7, ROLLA, MO 65401-4691
(573) 230-6703
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2005012267
MO
Other
Enumeration date
06/14/2006
Last updated
07/08/2007
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