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Individual

MS. KIMBERLY MOUTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1451 GREEN OAK CIR, LAWRENCEVILLE, GA 30043-5449
(770) 377-9548
Mailing address
2133 LAWRENCEVILLE SUWANEE RD STE 12, SUWANEE, GA 30024-2649
(770) 377-9548

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary

Other

Enumeration date
04/12/2019
Last updated
04/12/2019
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