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1124072087
BRUCE L JACKSON
APPLE VALLEY, CA
NPI
1124072087
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: CA PA14185)
Enumeration Date
2006-05-22
Last Update Date
2007-07-08
Business Address
Mr. BRUCE L JACKSON P.A.
15863 KASOTA RD
APPLE VALLEY, CA 92307-4507
Phone number: 760-948-1454
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Mailing Address
Mr. BRUCE L JACKSON P.A.
11919 HESPERIA RD
HESPERIA, CA 92345-1855
Phone number: 760-948-1454
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