Individual
RUSSELL J CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 OAKLAND AVE, ELKHART, IN 46517-1533
(574) 533-1234
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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