Individual
KENNETH RIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5449 TEMPE CT, FAYETTEVILLE, NC 28303-2749
(910) 583-4635
Mailing address
220 WILDLIFE WAY, FAYETTEVILLE, NC 28314-1378
(910) 583-4635
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
11/29/2022
Last updated
11/29/2022
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