Individual
DIANE KECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
107 SHEYENNE ST, WEST FARGO, ND 58078-1728
(701) 281-2777
Mailing address
219 2ND AVE W APT 18, WEST FARGO, ND 58078-1744
(701) 799-4174
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
718
ND
Other
Enumeration date
11/20/2006
Last updated
07/08/2007
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