Individual
COREY BRISSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5124 ARBOR ST, PHILADELPHIA, PA 19120-3602
(215) 287-3818
Mailing address
5124 ARBOR ST, PHILADELPHIA, PA 19120-3602
(215) 287-3818
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/28/2023
Last updated
04/28/2023
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