MALLORY MICKUS

BLOOMINGTON, IN
NPI1659785137
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IN  36001700A)
Enumeration Date2014-06-12
Last Update Date2014-06-12
Business Address
-- MALLORY MICKUS
2200 W SUDBURY DR E2
BLOOMINGTON, IN 47403-3736
Phone number: 219-921-4028
Mailing Address
-- MALLORY MICKUS
2200 W SUDBURY DR E2
BLOOMINGTON, IN 47403-3736
Phone number:
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