LATRESE JACKSON

LIZELLA, GA
NPI1295316511
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy335E00000X Prosthetic/Orthotic Supplier
Enumeration Date2021-04-19
Last Update Date2021-04-19
Business Address
LATRESE JACKSON
2324 GWENDALE DR W
LIZELLA, GA 31052-3550
Phone number: 478-250-4601
Mailing Address
LATRESE JACKSON
2324 GWENDALE DR W
LIZELLA, GA 31052-3550
Phone number: 478-250-4601
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