Individual
DIEDRA Y KINNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
240 WEST JENSEN ST., FREDONIA, AZ 86022-0491
(928) 925-0388
Mailing address
240 WEST JENSEN ST., FREDONIA, AZ 86022
(928) 925-0388
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
4750887
AZ
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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