Individual
MR. ANTHONY DAVID KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
2435 GREENWAY DR NE, SALEM, OR 97301-4535
(503) 991-6619
Mailing address
619 JASMINE CIR, INDEPENDENCE, OR 97351-9578
(503) 838-4866
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
171M00000X
OR
Other
Enumeration date
06/01/2007
Last updated
07/08/2007
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