Individual
KELLI MARIE CONKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
449 IVORY RD, FREWSBURG, NY 14738-9724
(716) 467-2398
Mailing address
449 IVORY RD, FREWSBURG, NY 14738
(716) 467-2398
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
315663
NY
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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