JONATHAN JACKSON

PADUCAH, KY
NPI1164713467
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center)
Enumeration Date2011-04-21
Last Update Date2011-04-21
Business Address
JONATHAN JACKSON
425 BROADWAY ST
PADUCAH, KY 42001-0713
Phone number: 270-444-3620
Mailing Address
JONATHAN JACKSON
425 BROADWAY ST
PADUCAH, KY 42001-0713
Phone number:
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