Individual
MR. GLEN MOORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2625 S DURANGO DR, APT 201, LAS VEGAS, NV 89117-2881
(313) 244-5112
Mailing address
2625 S DURANGO DR, APT 201, LAS VEGAS, NV 89117-2881
(313) 244-5112
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
06/14/2013
Last updated
06/14/2013
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