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Individual

KENNETH FOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
8562 122ND AVE N, CHAMPLIN, MN 55316-3588
(612) 867-6629
Mailing address
8562 122ND AVE N, CHAMPLIN, MN 55316-3588
(612) 867-6629

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
0561
FL

Other

Enumeration date
07/08/2013
Last updated
07/08/2013
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Product
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  • EDI platform