JACK BRYAN VANCE

CORBIN, KY
NPI1184022212
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2014-12-05
Last Update Date2014-12-05
Business Address
-- JACK BRYAN VANCE BA
1203 AMERICAN GREETING CARD RD
CORBIN, KY 40701-4811
Phone number: 606-528-7010
Mailing Address
-- JACK BRYAN VANCE BA
PO BOX 568
CORBIN, KY 40702-0568
Phone number:
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