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1992100275
KELLY BROCK
TERRE HAUTE, IN
NPI
1992100275
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IN 36002335A)
Enumeration Date
2014-10-28
Last Update Date
2014-10-28
Business Address
-- KELLY BROCK LAT, ATC
567 N 5TH ST
TERRE HAUTE, IN 47809-1903
Phone number: 812-237-2378
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Mailing Address
-- KELLY BROCK LAT, ATC
567 N 5TH ST
TERRE HAUTE, IN 47809-1903
Phone number:
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