Individual
CORRINA REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
402 N HIGH ST, JACKSON, OH 45640-1214
(740) 577-2536
Mailing address
59A COURT ST, GALLIPOLIS, OH 45631-1138
(740) 577-2536
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
SL974812
OH
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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