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1457633711
BRYAN JUDSON SMITH
SAN DIEGO, CA
NPI
1457633711
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2011-09-13
Last Update Date
2011-09-13
Business Address
Mr. BRYAN JUDSON SMITH Dive IDC
34101 FARENHOLT AVE
SAN DIEGO, CA 92134-7000
Phone number: 619-532-6064
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Mailing Address
Mr. BRYAN JUDSON SMITH Dive IDC
62468 HIGHWAY 49
LINEVILLE, AL 36266-4923
Phone number: 240-478-1870
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