Individual
KELLY DAMIAN FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1543 LIGONIER ST, LATROBE, PA 15650-2955
(724) 537-7766
(724) 537-0114
Mailing address
1543 LIGONIER ST, LATROBE, PA 15650-2955
(724) 537-7766
(724) 537-0114
Taxonomy
Speciality
Code
Description
License number
State
176P00000X
Funeral Director
Primary
FD-014493-L
PA
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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