Individual
KELLY FEWSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 BOOTH ST, ELKTON, MD 21921-5657
(410) 996-3400
Mailing address
200 BOOTH ST, ELKTON, MD 21921-5657
(410) 996-3400
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LGP5723
MD
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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