RUSSELL KENWORTHY

LONG BEACH, MS
NPI1417362559
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: MS  AT0159)
Enumeration Date2014-06-27
Last Update Date2014-06-27
Business Address
-- RUSSELL KENWORTHY ATC
312 RITA LN
LONG BEACH, MS 39560-4338
Phone number: 228-234-4959
Mailing Address
-- RUSSELL KENWORTHY ATC
312 RITA LN
LONG BEACH, MS 39560-4338
Phone number: 228-234-4959
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