Individual
JUSTIN B CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
511 NE 10TH ST, ABILENE, KS 67410-2153
(785) 263-6664
Mailing address
511 NE 10TH ST, PO BOX 123, ABILENE, KS 67410-2153
(785) 263-6664
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2400410
KS
Other
Enumeration date
05/17/2006
Last updated
07/12/2007
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