Individual
KELLY LAROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1221 NASHVILLE HWY, LEWISBURG, TN 37091-2221
(860) 455-3168
Mailing address
9513 ELK RIDGE RD, MT PLEASANT, TN 38474-2212
(860) 455-3168
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/27/2015
Last updated
01/27/2015
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