Individual
KATIE ELLEN HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1169 EMILY ST, REDLANDS, CA 92374-3765
(808) 398-6680
Mailing address
1169 EMILY ST, REDLANDS, CA 92374-3765
(808) 398-6680
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
B8378503
CA
Other
Enumeration date
07/02/2010
Last updated
07/02/2010
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