Individual
DENISE SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6415 BENHAM DRIVE, FORT WAYNE, IN 46815
(260) 445-8770
Mailing address
6415 BENHAM DR, FORT WAYNE, IN 46815-8319
(260) 445-8770
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
06002110A
IN
Other
Enumeration date
07/07/2014
Last updated
07/07/2014
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