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1063997922
KENNETH STANDRIDGE
RUSSELLVILLE, AR
NPI
1063997922
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2018-09-26
Last Update Date
2018-09-26
Business Address
KENNETH STANDRIDGE
210 N SHAMROCK BLVD
RUSSELLVILLE, AR 72802-9658
Phone number: 501-315-3344
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Mailing Address
KENNETH STANDRIDGE
PO BOX 1589
BENTON, AR 72018-1589
Phone number: 501-315-3344
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