Individual
KEITH ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13 TEMPLE ST, QUINCY, MA 02169-5110
(617) 471-8400
Mailing address
15 CEDAR ST, KINGSTON, MA 02364-1618
(857) 939-8191
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
MA
Other
Enumeration date
10/11/2013
Last updated
10/11/2013
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