Individual
MR. CHARLES WARREN CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
19577 FM 2854 RD, MONTGOMERY, TX 77316-3150
(936) 537-0948
Mailing address
19577 FM 2854 RD, MONTGOMERY, TX 77316-3150
(936) 537-0948
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT038025
TX
Other
Enumeration date
12/11/2010
Last updated
12/11/2010
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