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1700096955
KELLY JANE BLACK
PHOENIX, AZ
NPI
1700096955
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207PS0010X Emergency Medicine, Sports Medicine
(Licence: AZ 24733)
Enumeration Date
2007-05-23
Last Update Date
2007-07-08
Business Address
Dr. KELLY JANE BLACK MD
4530 N 32ND ST STE 102
PHOENIX, AZ 85018-3357
Phone number: 602-493-1626
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Mailing Address
Dr. KELLY JANE BLACK MD
3119 E PUGET AVE
PHOENIX, AZ 85028-5328
Phone number: 602-493-1626
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