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1649295825
BRENT M. FAURE
POCATELLO, ID
NPI
1649295825
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID 008)
Enumeration Date
2006-07-12
Last Update Date
2007-07-08
Business Address
Mr. BRENT M. FAURE MS, ATC
13279 N MOONGLOW LN
POCATELLO, ID 83202-5122
Phone number: 208-237-2971
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Mailing Address
Mr. BRENT M. FAURE MS, ATC
13279 MOONGLOW
POCATELLO, ID 83202-5122
Phone number: 208-237-2971
Copy
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