Individual
GRACEY MAE EDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
712 LAUREL HILL RD, BANGOR, PA 18013-5564
(520) 343-8221
Mailing address
712 LAUREL HILL RD, BANGOR, PA 18013-5564
(520) 343-8221
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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