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Individual

COREY SHORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
423 GREAT OAK DR, WAITE PARK, MN 56387-2507
(218) 287-4338
Mailing address
891 BELSLY BLVD, MOORHEAD, MN 56560-5055

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary

Other

Enumeration date
06/18/2019
Last updated
06/18/2019
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