Individual
MARY KIM QUALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSORT/L
Contact information
Practice address
300 DONALDSON RD, NEBO, KY 42441-9339
(270) 249-3910
Mailing address
300 DONALDSON RD, NEBO, KY 42441-9339
(270) 249-3910
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
KY-R3361
KY
Other
Enumeration date
08/25/2009
Last updated
08/25/2009
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