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1740744994
KALISSA BANNISTER
CHARLESTON, WV
NPI
1740744994
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist Athletic Trainer
Enumeration Date
2019-01-22
Last Update Date
2019-01-22
Business Address
KALISSA BANNISTER
408 JERICK CIR
CHARLESTON, WV 25302-4470
Phone number: 304-881-1186
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Mailing Address
KALISSA BANNISTER
408 JERICK CIR
CHARLESTON, WV 25302-4470
Phone number:
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