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Individual

MR. SHANE WESLEY CLEMENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7609 ALBERT RD, SAGINAW, MN 55779-9676
(218) 390-6415
Mailing address
7609 ALBERT RD, SAGINAW, MN 55779-9676
(218) 390-6415

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary

Other

Enumeration date
12/01/2008
Last updated
12/01/2008
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