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1184201584
DEREK RUSSELL BASS
KINGSPORT, TN
NPI
1184201584
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-03-24
Last Update Date
2021-03-24
Business Address
DEREK RUSSELL BASS DO
130 W RAVINE RD STE 9C
KINGSPORT, TN 37660-3837
Phone number: 423-224-3292
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Mailing Address
DEREK RUSSELL BASS DO
130 W RAVINE RD STE 9C
KINGSPORT, TN 37660-3837
Phone number: 423-224-3292
Copy
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