JACK LEE SUDDRETH

PETERSBURG, VA
NPI1083676274
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: VA  0024164859)
Enumeration Date2006-04-04
Last Update Date2007-07-08
Business Address
-- JACK LEE SUDDRETH CRNA
801 S ADAMS ST
PETERSBURG, VA 23808-2938
Phone number: 804-862-5000
Mailing Address
-- JACK LEE SUDDRETH CRNA
PO BOX 740209 DEPT 1041
ATLANTA, GA 30374-0209
Phone number: 941-360-1566
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