Individual
JORDAN TOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 248-4371
Mailing address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/31/2018
Last updated
10/31/2018
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