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Kelvin Wren

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NPI Number Detailed Information

Provider Information:

Name: Kelvin Wren
Gender: M
Provider License Number If Given: 39598

NPI Information:

NPI: 1033118633
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 174 MURRAY GUARD DR SUITE D
Jackson, TN 38305
Phone Number: 7316604916
Fax Number: 7316606759

Provider Business Practice Location Address:

Address: 174 MURRAY GUARD DR SUITE D
Jackson, TN 38305
Phone Number: 7316604916
Fax Number: 7316606759

Provider Taxonomy:

Primary: 2083P0500X
Secondary (if any): 202C00000X
State: TN

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