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1184216749
OTIS MACK
CHARLESTON, WV
NPI
1184216749
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
Enumeration Date
2021-02-05
Last Update Date
2021-02-05
Business Address
OTIS MACK
1599 2ND AVE
CHARLESTON, WV 25387-2514
Phone number: 304-344-0586
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Mailing Address
OTIS MACK
PO BOX 20112
CHARLESTON, WV 25362-1112
Phone number:
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