Individual
MR. KELLY JAY MCBRIDE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC/L
Contact information
Practice address
709 W. ADAMS ST. #4, MACOMB, IL 61455-1367
(217) 473-8362
Mailing address
709 W. ADAMS ST. #4, MACOMB, IL 61455-1367
(217) 473-8362
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
03/24/2006
Last updated
07/08/2007
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