Individual
MRS. MARY ELLEN BRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
298 TROY AVE, MARTINSBURG, WV 25404-5455
(304) 283-2842
Mailing address
298 TROY AVE, MARTINSBURG, WV 25404-5455
(304) 283-2842
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2004-1439
WV
Other
Enumeration date
12/20/2007
Last updated
12/20/2007
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