Individual
JERRY TUCKER III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18336 AVON AVE, DETROIT, MI 48219-2954
(313) 704-3586
Mailing address
18336 AVON AVE, DETROIT, MI 48219-2954
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501005564
MI
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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