Provider Information for 1225294473
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CICELY AMBER BROOKS BA
Sex: Female
NPI: 1225294473
Last Updated: 2008-08-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1225294473 | ||||||||
| Enumeration Date | 2008-08-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 9054 GRAY, TN 37615-9054 United States Phone: 423-467-3600 | Fax:423-467-3644 | ||||||||
| Primary Practice Address | 109 W WATAUGA AVE JOHNSON CITY, TN 37604-5621 United States Phone: 423-232-2600 | Fax:423-232-2646 | ||||||||
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