Individual
MR. JESSE P AMBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT,ATC
Contact information
Practice address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
(903) 531-0179
Mailing address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
(903) 531-0179
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT2013
TX
Other
Enumeration date
09/23/2007
Last updated
09/23/2007
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