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1245461540
CAROLYN MARGARET BLACK
WASILLA, AK
NPI
1245461540
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: AK 119902014)
Enumeration Date
2009-08-04
Last Update Date
2014-07-01
Business Address
Mrs. CAROLYN MARGARET BLACK ATC
1001 E BOGARD RD
WASILLA, AK 99654-7114
Phone number: 907-376-2225
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Mailing Address
Mrs. CAROLYN MARGARET BLACK ATC
1001 E BOGARD RD
WASILLA, AK 99654-7114
Phone number: 907-376-2225
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