Individual
MISS AUDREY MANIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
1205 APPLEGATE LN, CLARKSVILLE, IN 47129-9608
(812) 283-8383
Mailing address
1483 SAINT JAMES CT, LOUISVILLE, KY 40208-2145
(931) 581-2129
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12362
IN
Other
Enumeration date
05/05/2016
Last updated
05/05/2016
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