Individual
TABITHA MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2001 ALFORD PARK DR, KENOSHA, WI 53140-1927
(262) 551-8500
Mailing address
249 MAIN ST, KINGSTON, IL 60145-6800
(815) 218-4924
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/22/2019
Last updated
01/22/2019
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