JERRY LEE CLARK

PHILA, PA
NPI1356521371
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101Y00000X Counselor
Enumeration Date2007-11-07
Last Update Date2007-11-07
Business Address
Mr. JERRY LEE CLARK M.H.S.
112 N BROAD ST RM 821
PHILA, PA 19102-1510
Phone number: 215-568-0860
Mailing Address
Mr. JERRY LEE CLARK M.H.S.
6913 LIMEKILN PIKE
PHILADELPHIA, PA 19138-2007
Phone number: 215-548-1308
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