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1063114742
MICHAEL THOMAS LONG
IDAHO FALLS, ID
NPI
1063114742
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2023-03-20
Last Update Date
2023-03-20
Business Address
MICHAEL THOMAS LONG DO
3100 CHANNING WAY
IDAHO FALLS, ID 83404-7533
Phone number: 208-973-2144
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Mailing Address
MICHAEL THOMAS LONG DO
3100 CHANNING WAY
IDAHO FALLS, ID 83404-7533
Phone number:
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