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1851750061
SAM JACKSON
MESA, AZ
NPI
1851750061
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
(Licence: AZ LAC-15314)
Enumeration Date
2016-02-16
Last Update Date
2016-02-16
Business Address
-- SAM JACKSON LAC
4250 E FLORIAN AVE BUILDING #1
MESA, AZ 85206-2797
Phone number: 480-844-1653
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Mailing Address
-- SAM JACKSON LAC
924 N COUNTRY CLUB DR BUILDING #1
MESA, AZ 85201-4108
Phone number: 480-969-3800
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