Individual
RONDAL KEITH BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
TAZEWELL MEDICAL CLINIC 1442 NORTH BROAD STREET, SUITE 7, TAZEWELL, TN 37879
(423) 626-6145
(423) 526-2804
Mailing address
1037 OLD JACKSOBORO ROAD, CUMBERLAND GAP, TN 37724-4444
(423) 869-9980
(423) 526-2804
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
TN
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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