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1740756758
ALFRED CONWAY PORTER
JACKSON, MS
NPI
1740756758
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
3104A0625X Assisted Living Facility, Assisted Living, Mental Illness
Enumeration Date
2018-10-17
Last Update Date
2018-10-17
Business Address
Mr. ALFRED CONWAY PORTER MBA
3201 HOLLYWOOD AVE
JACKSON, MS 39213-6754
Phone number: 601-665-3402
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Mailing Address
Mr. ALFRED CONWAY PORTER MBA
4358 CALIFORNIA AVE
JACKSON, MS 39213-4707
Phone number:
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