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1366931156
WILLIE TIMOTHY DONALD
GARY, IN
NPI
1366931156
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2018-05-07
Last Update Date
2018-05-07
Business Address
WILLIE TIMOTHY DONALD technician
4755 JEFFERSON ST
GARY, IN 46408-4530
Phone number: 219-344-8909
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Mailing Address
WILLIE TIMOTHY DONALD technician
4755 JEFFERSON ST
GARY, IN 46408-4530
Phone number: 219-344-8909
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