MIA PROVENZANO

MESA, AZ
NPI1093199499
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
Enumeration Date2015-07-15
Last Update Date2015-07-15
Business Address
-- MIA PROVENZANO
1320 S VAL VISTA DR APT 1066
MESA, AZ 85204-6491
Phone number: 989-964-1089
Mailing Address
-- MIA PROVENZANO
1320 S VAL VISTA DR APT 1066
MESA, AZ 85204-6491
Phone number:
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