WILLIAM JACOB DIVETT

PORTALES, NM
NPI1588912893
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy104100000X Social Worker
(Licence: NM  I08039)
Enumeration Date2012-08-16
Last Update Date2012-08-16
Business Address
-- WILLIAM JACOB DIVETT LISW
1515 W FIR ST
PORTALES, NM 88130-5703
Phone number: 575-356-6695
Mailing Address
-- WILLIAM JACOB DIVETT LISW
PO BOX 843
PORTALES, NM 88130-0843
Phone number: 575-356-6695
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