Individual
DERICK MICHAEL BOSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1940 BOYD RD, SCRANTON, SC 29591-5835
(843) 389-9201
Mailing address
HC 86 BOX 418C, FORT ASHBY, WV 26719-9719
(301) 697-2500
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2348
SC
Other
Enumeration date
11/02/2011
Last updated
11/02/2011
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