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1093575086
IAN RUSSELL
GLENDALE, AZ
NPI
1093575086
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2024-03-19
Last Update Date
2024-03-19
Business Address
IAN RUSSELL
19555 N 59TH AVE
GLENDALE, AZ 85308-6813
Phone number: 623-572-3200
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Mailing Address
IAN RUSSELL
19555 N 59TH AVE
GLENDALE, AZ 85308-6813
Phone number: 623-572-3200
Copy
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