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1659785137
MALLORY MICKUS
BLOOMINGTON, IN
NPI
1659785137
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist Athletic Trainer
(Licence: IN 36001700A)
Enumeration Date
2014-06-12
Last Update Date
2014-06-12
Business Address
MALLORY MICKUS
2200 W SUDBURY DR E2
BLOOMINGTON, IN 47403-3736
Phone number: 219-921-4028
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Mailing Address
MALLORY MICKUS
2200 W SUDBURY DR E2
BLOOMINGTON, IN 47403-3736
Phone number:
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