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Individual

AMY MARIE KUBAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2450 RISNER DRIVE, ELLSWORTH AIR FORCE BASE HEALTH AND WELLNESS CENTER, ELLSWORTH AFB, SD 57706
(605) 385-2349
Mailing address
4521 HOMESTEAD ST, #303, RAPID CITY, SD 57703-0223
(970) 420-1642

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
00915063

Other

Enumeration date
10/24/2008
Last updated
02/04/2009
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