ROBERT BRAGG

JACKSON, WY
NPI1225469661
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WY  LAT-202)
Enumeration Date2013-12-11
Last Update Date2013-12-11
Business Address
-- ROBERT BRAGG LAT
610 W BROADWAY AVE STE L1
JACKSON, WY 83001-8213
Phone number: 307-733-3908
Mailing Address
-- ROBERT BRAGG LAT
PO BOX 11390
JACKSON, WY 83002-1390
Phone number: 307-733-3908
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