Individual
KELLYRAE BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 PRAIRIE CITY RD, FOLSOM, CA 95630-9501
(916) 370-8154
Mailing address
2404 LOMA VISTA DR, SACRAMENTO, CA 95825-0310
(916) 370-8154
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
55213
CA
Other
Enumeration date
12/11/2014
Last updated
12/11/2014
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