Individual
MRS. KELLEY ANN MOORE-SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1645 MAPLEWOOD DR, STREETSBORO, OH 44241-5662
(330) 626-3031
Mailing address
1579 RUSSELL DR, STREETSBORO, OH 44241-8349
(330) 422-1304
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2007563
—
OH
Enumeration date
06/25/2007
Last updated
07/08/2007
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