Organization
MYSTIC MYRTLES STUFF LLC
Active
Other names
Mystic Myrtles Stuff LLC Massage
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL JOHN MCINTYRE (CFO)
(928) 753-3148
Entity
Organization
Contact information
Practice address
1711 N STOCKTON HILL RD, SUITE A, KINGMAN, AZ 86401-4673
(928) 753-3148
(928) 753-3148
Mailing address
1711 N STOCKTON HILL RD, SUITE A, KINGMAN, AZ 86401-4673
(928) 753-3148
(928) 753-3148
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT04442P
AZ
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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