Individual
MARY LESLIE MUSUMECCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6014 LAKERIDGE AVE, TUSCALOOSA, AL 35406-1489
(205) 331-9560
Mailing address
6014 LAKERIDGE AVE, TUSCALOOSA, AL 35406-1489
(205) 331-9560
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
R011463223
AL
Other
Enumeration date
06/24/2022
Last updated
06/24/2022
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