DEREK RUSSELL BASS

KINGSPORT, TN
NPI1184201584
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2021-03-24
Last Update Date2021-03-24
Business Address
DEREK RUSSELL BASS DO
130 W RAVINE RD STE 9C
KINGSPORT, TN 37660-3837
Phone number: 423-224-3292
Mailing Address
DEREK RUSSELL BASS DO
130 W RAVINE RD STE 9C
KINGSPORT, TN 37660-3837
Phone number: 423-224-3292
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