Individual
MISS KIMBERLY A. DIVINCENZO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2345 MAIN ST, GLASTONBURY, CT 06033-2211
(860) 633-5572
Mailing address
318 WELLINGTON RD, BUFFALO, NY 14216-1915
(716) 838-5892
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000561-1
NY
Other
Enumeration date
04/28/2006
Last updated
07/08/2007
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