Individual
JESSICA M BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
169 HIGHLAND DR, MANDEVILLE, LA 70471
(504) 621-2912
Mailing address
169 HIGHLAND DR, MANDEVILLE, LA 70471
(504) 621-2912
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
5969
LA
Other
Enumeration date
05/14/2009
Last updated
05/14/2009
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