Individual
MISS SUSAN RENEE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, MS, LAT
Contact information
Practice address
9030 MONTICELLO RD, WESSON, MS 39191-9027
(601) 668-2932
Mailing address
9030 MONTICELLO RD, WESSON, MS 39191-9027
(601) 668-2932
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AT0476
MS
Other
Enumeration date
09/26/2010
Last updated
09/26/2010
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