MRS. Shannon Jackie Clark

NPI #1700940855 in Vail, Arizona

Provider Information

NPI Number: 1700940855
Entity Type: Individual
Name: MRS. Shannon Jackie Clark
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Contractor
Enumeration Date: Dec 21, 2006
Last Updated: Dec 26, 2024

Practice Location

Address: 12729 S OX CART TRL
City: Vail
State: Arizona
ZIP Code: 85641-9232
Phone: (512) 214-2841

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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