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Individual

KHAILITHA FAE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L. AC, DOM

Contact information

Practice address
119 GARDEN ST STE B, PRESCOTT, AZ 86305-2913
(928) 225-1655
Mailing address
1539 OREGON AVE, PRESCOTT, AZ 86305-2225
(928) 225-1655

Taxonomy

Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
0780
AZ
171100000X
Acupuncturist
1020
NM

Other

Enumeration date
05/07/2014
Last updated
05/07/2014
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