Individual
MR. JACOB S QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PRSS
Contact information
Practice address
2157 GREENBRIER ST, CHARLESTON, WV 25311-9623
(304) 553-0051
Mailing address
2157 GREENBRIER ST, CHARLESTON, WV 25311-9623
(304) 553-0051
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
24-9103
WV
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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