Individual
RUSSELL MACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
480 N CAMPUS WALK, FAYETTEVILLE, AR 72701-4006
(479) 575-4258
Mailing address
439 W SPRUCE ST, FAYETTEVILLE, AR 72703-1836
(908) 295-8406
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/23/2023
Last updated
06/23/2023
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