Individual
MISS JILL MARIE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
81 BRIDGE ST, YARMOUTH, ME 04096-6744
(207) 846-9696
Mailing address
171 ALLEN AVE, PORTLAND, ME 04103-3714
(207) 233-1692
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ES39677
ME
Other
Enumeration date
02/08/2009
Last updated
02/08/2009
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