Individual
KENNETH HORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
143 E CRUSSELLE ST, ROBERTA, GA 31078-4866
(478) 836-2994
Mailing address
PO BOX 900, ROBERTA, GA 31078-0900
(478) 836-2994
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
—
—
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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