Individual
KELLY SUE HARGIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24994 E FISHBACK RD, MARSHALL, IL 62441-4695
(217) 264-5355
Mailing address
24994 E FISHBACK RD, MARSHALL, IL 62441-4695
(217) 264-5355
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/13/2011
Last updated
06/13/2011
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