Most Relevant Information
Provider Data
| NPI Number: | 1003540857 |
| Provider Name: | TIA MARIE THROCKMORTON |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/15/2022 |
| Last Updated: | 07/15/2022 |
Provider Practice Location
5512 BIG TYLER RD
CROSS LANES
WV
253131304
Practice Location Phone/Fax
| Phone: | 3047669830 |
| Fax: |
Provider Mailing Location
5512 BIG TYLER RD
CROSS LANES
WV
253131304
Provider Mailing Phone/Fax
| Phone: | 3047669830 |
| Fax: |