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1962611202
EDGAR VINCENT CLARK
VIDALIA, GA
NPI
1962611202
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
235Z00000X Speech-Language Pathologist
(Licence: GA SLP004577)
Enumeration Date
2007-05-22
Last Update Date
2007-07-08
Business Address
MR. EDGAR VINCENT CLARK CCC-S
101 HARRIS INDUSTRIAL BLVD
VIDALIA, GA 30474-8845
Phone number: 912-537-2044
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Mailing Address
MR. EDGAR VINCENT CLARK CCC-S
PO BOX 383
GLENWOOD, GA 30428-0383
Phone number: 912-568-7687
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