Individual
LATOYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4918 NEO PKWY, GARFIELD HTS, OH 44128-3104
(216) 510-7941
Mailing address
4918 NEO PKWY, GARFIELD HTS, OH 44128-3104
(216) 510-7941
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
189795
OH
Other
Enumeration date
03/15/2015
Last updated
03/15/2015
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