Individual
MR. DANHAI L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(617) 543-6653
Mailing address
237 LANTERN RD APT 49, REVERE, MA 02151-1264
(617) 412-1683
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
S38878241
MA
Other
Enumeration date
01/24/2012
Last updated
01/24/2012
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