Individual
MISS CRYSTAL B MABRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15787 COOSE HOLLOW DR, ROGERS, AR 72756-8966
(479) 925-3526
Mailing address
15787 COOSE HOLLOW DR, ROGERS, AR 72756-8966
(479) 925-3526
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153757783
—
AR
Enumeration date
04/28/2008
Last updated
04/28/2008
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