CHARLES PERRY GREEN

KAMIAH, ID
NPI1811266927
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy172V00000X Community Health Worker
(Licence: ID  003866467)
Enumeration Date2011-12-19
Last Update Date2011-12-19
Business Address
Mr. CHARLES PERRY GREEN
3361 NO KID RD
KAMIAH, ID 83536-5002
Phone number: 208-553-0284
Mailing Address
Mr. CHARLES PERRY GREEN
3361 NO KID RD
KAMIAH, ID 83536-5002
Phone number: 208-553-0284