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1457490088
DENNIS MARK MATLOCK
INDIO, CA
NPI
1457490088
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Former Name
DENNIS MARK MATLOCK
Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2007-02-06
Last Update Date
2007-07-08
Business Address
-- DENNIS MARK MATLOCK RS1503
83912 AVENUE 45 STE 9
INDIO, CA 92201-3338
Phone number: 760-347-0754
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Mailing Address
-- DENNIS MARK MATLOCK RS1503
PO BOX 2023
YUCCA VALLEY, CA 92286-2023
Phone number: 760-347-0754
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