Individual
LESLIE MCKENNIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1316 RIVERBROOK DR, HERMITAGE, TN 37076-3569
(615) 568-6878
Mailing address
1316 RIVERBROOK DR, HERMITAGE, TN 37076-3569
(615) 568-6878
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
144093593
TN
Other
Enumeration date
05/09/2022
Last updated
05/09/2022
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