Individual
MISS BENITA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6102 W TOWNLEY AVE, GLENDALE, AZ 85302-4518
(623) 915-9363
Mailing address
6102 W TOWNLEY AVE, GLENDALE, AZ 85302-4518
(623) 915-9363
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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