KIESHA MARIE BULLOUGH

CLARKSBURG, WV
NPI1700113412
Former NameKIESHA MARIE WINE
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: WV  01444)
Enumeration Date2009-11-17
Last Update Date2016-06-17
Business Address
-- KIESHA MARIE BULLOUGH PA-C
700 OAKMOUND RD
CLARKSBURG, WV 26301-9398
Phone number: 304-623-6330
Mailing Address
-- KIESHA MARIE BULLOUGH PA-C
700 OAKMOUND RD
CLARKSBURG, WV 26301-9398
Phone number: 304-623-6330
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