IVAN VICENTE

ELLSWORTH AFB, SD
NPI1710201553
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1710I1003X Military Health Care Provider, Independent Duty Medical Technicians
Enumeration Date2010-03-23
Last Update Date2010-03-23
Business Address
-- IVAN VICENTE IDMT
433 BLACK ELK CT
ELLSWORTH AFB, SD 57706-1847
Phone number: 605-521-3502
Mailing Address
-- IVAN VICENTE IDMT
433 BLACK ELK CT
ELLSWORTH AFB, SD 57706-1847
Phone number: 605-521-3502
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