Individual
MR. KEITH DUANE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7426 S CAMINO VAHCOM, TUCSON, AZ 85757
(520) 879-5693
Mailing address
2237 S MCFEE AVENUE, TUCSON, AZ 85713
(817) 681-3776
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-11831
AZ
Other
Enumeration date
12/23/2015
Last updated
12/23/2015
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