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1073975033
KIMOTHY SPARKS
GALLUP, NM
NPI
1073975033
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
163W00000X Registered Nurse
(Licence: NM RN-72248)
Enumeration Date
2016-03-28
Last Update Date
2016-03-28
Business Address
KIMOTHY SPARKS RN, JD
516 E NIZHONI BLVD
GALLUP, NM 87301-5748
Phone number: 505-722-1533
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Mailing Address
KIMOTHY SPARKS RN, JD
516 E NIZHONI BLVD
GALLUP, NM 87301-5748
Phone number: 505-722-1533
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