TERRY BLAYLOCK

MILWAUKEE, WI
NPI1710154836
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy172V00000X Community Health Worker
(Licence: WI  1068-019)
Enumeration Date2008-05-08
Last Update Date2008-05-08
Business Address
-- TERRY BLAYLOCK PTA1
3238 N 2ND ST
MILWAUKEE, WI 53212-2021
Phone number: 414-731-2616
Mailing Address
-- TERRY BLAYLOCK PTA1
3238 N 2ND ST
MILWAUKEE, WI 53212-2021
Phone number: 414-731-2616
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