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Individual

LA KEISHA FAIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MAE, ATC,LAT

Contact information

Practice address
1 CUMBERLAND SQUARE, LEBANON, TN 37087
(615) 453-6327
Mailing address
1 CUMBERLAND SQ, LEBANON, TN 37087-3408
(615) 453-6327

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
0000001348
TN

Other

Enumeration date
07/31/2014
Last updated
07/31/2014
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