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1134331200
ANTONIO JERMAINE RUCKER
LONG BEACH, CA
NPI
1134331200
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2007-05-03
Last Update Date
2007-07-08
Business Address
-- ANTONIO JERMAINE RUCKER
40 ROSWELL AVE
LONG BEACH, CA 90803-2952
Phone number: 562-711-1147
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Mailing Address
-- ANTONIO JERMAINE RUCKER
40 ROSWELL AVE
LONG BEACH, CA 90803-2952
Phone number:
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