Individual
KELLY PRESTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 GROTTO STREET N, ST PAUL, MN 55104
(651) 760-3236
(651) 222-6025
Mailing address
500 GROTTO ST N, SAINT PAUL, MN 55104-1754
(651) 760-3236
(651) 222-6025
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/21/2017
Last updated
11/21/2017
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