Individual
MR. TRACY JOSEPH JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CEO
Contact information
Practice address
6529 N WOODSTOCK ST, PHILADELPHIA, PA 19138-3114
(267) 345-5968
Mailing address
6529 N WOODSTOCK ST, PHILADELPHIA, PA 19138-3114
(267) 345-5968
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
22428191
PA
Other
Enumeration date
07/13/2022
Last updated
07/13/2022
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