Individual
AMIE MARION BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
29099 HOSPITAL RD, SUITE 103, LAKE ARROWHEAD, CA 92352-1476
(909) 337-5928
(909) 337-4027
Mailing address
PO BOX 1476, LAKE ARROWHEAD, CA 92352-1476
(909) 337-5928
(909) 337-4027
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
COB06240
CA
Other
Enumeration date
05/07/2007
Last updated
07/08/2007
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