BRYAN BLACK

FORT WAYNE, IN
NPI1407358377
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IN  36002703A)
Enumeration Date2018-03-06
Last Update Date2018-03-06
Business Address
BRYAN BLACK MAT, LAT, ATC, CKTP
3946 ICE WAY FORT WAYNE
FORT WAYNE, IN 46808
Phone number: 517-425-4996
Mailing Address
BRYAN BLACK MAT, LAT, ATC, CKTP
3946 ICE WAY FORT WAYNE
FORT WAYNE, IN 46808
Phone number: 517-425-4996
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