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1174077614
KELLY ROUGHGARDEN
STOCKTON, CA
NPI
1174077614
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2016-08-13
Last Update Date
2016-08-13
Business Address
-- KELLY ROUGHGARDEN
5405 N PERSHING AVE STE. C-1
STOCKTON, CA 95207-5451
Phone number: 209-476-1959
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Mailing Address
-- KELLY ROUGHGARDEN
3601 PACIFIC AVE
STOCKTON, CA 95211-0110
Phone number:
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