BRADLEY WAYNE PROCTOR

SAN DIEGO, CA
NPI1629635032
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date2019-05-21
Last Update Date2019-05-21
Business Address
Mr. BRADLEY WAYNE PROCTOR IDC
34101 FARENHOLT AVE
SAN DIEGO, CA 92134-7000
Phone number: 619-532-7968
Mailing Address
Mr. BRADLEY WAYNE PROCTOR IDC
530 GLENWOOD ST
BOSSIER CITY, LA 71111-2205
Phone number: 318-572-4557
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