Individual
HARRY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
236 MAIN STREET, MAMMOTH SPRINGS, AR 72554
(870) 625-3228
Mailing address
PO BOX 1100, WEST PLAINS, MO 65775-1100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R8A66
MO
Other
Enumeration date
11/13/2006
Last updated
07/08/2007
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