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1720737885
MARIVIC LUCENA DIEGO
LOCUST GROVE, GA
NPI
1720737885
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: GA PT016000)
Enumeration Date
2022-03-23
Last Update Date
2024-11-27
Business Address
MARIVIC LUCENA DIEGO
4959 BILL GARDNER PKWY STE 109
LOCUST GROVE, GA 30248-2915
Phone number: 770-914-9285
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Mailing Address
MARIVIC LUCENA DIEGO
2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE, IL 60515-1211
Phone number:
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