Individual
KENNY CLARK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3686 INGLESIDE RD, SHAKER HEIGHTS, OH 44122-5056
(216) 816-8129
Mailing address
11811 SHAKER BLVD, CLEVELAND, OH 44120-1931
(216) 584-8564
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
03/25/2024
Last updated
03/25/2024
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