Individual
MARY ITTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1002 HILLSHIRE DR, CLARKSVILLE, TN 37043-2106
(605) 254-2678
Mailing address
1002 HILLSHIRE DR, CLARKSVILLE, TN 37043-2106
(605) 254-2678
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
R024183
SD
Other
Enumeration date
07/31/2007
Last updated
09/28/2009
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