Individual
BRANDON VANVICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1109 JONES ST, KENNETT, MO 63857-3824
(573) 559-4328
Mailing address
1109 JONES ST, KENNETT, MO 63857-3824
(573) 559-4328
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/30/2014
Last updated
09/30/2014
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