Individual
MARY LOU FELLOWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14275 N COUNTY ROAD 24, WABASHA, MN 55981-7536
(651) 560-2111
Mailing address
14275 N COUNTY ROAD 24, WABASHA, MN 55981-7536
(651) 560-2111
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
1054348 AFC
MN
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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