Individual
RUSSELL KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
356 S MAIN ST, BLANDING, UT 84511-3830
(435) 678-2992
(435) 678-3116
Mailing address
356 S MAIN ST, BLANDING, UT 84511-3830
(435) 678-2992
(435) 678-3116
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
03/25/2011
Last updated
03/25/2011
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