MELVIN JACKSON

AVONDALE, AZ
NPI1831336411
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy322D00000X Residential Treatment Facility, Emotionally Disturbed Children
(Licence: AZ  11297)
Enumeration Date2009-01-19
Last Update Date2009-01-19
Business Address
-- MELVIN JACKSON
2415 N 124TH CIR
AVONDALE, AZ 85392-6509
Phone number: 602-841-3438
Mailing Address
-- MELVIN JACKSON
2415 N 124TH CIR
AVONDALE, AZ 85392-6509
Phone number: 602-841-3438
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