Individual
MIRANDA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
228 NW B ST, GRANTS PASS, OR 97526-2032
(541) 244-0111
Mailing address
228 NW B ST, GRANTS PASS, OR 97526-2032
(541) 244-0111
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01255
OR
Other
Enumeration date
04/13/2009
Last updated
06/13/2013
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