Individual
KENNETH PERRY VANTASSEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1410 WOODFAIR DR, RICHMOND, TX 77406-6609
(530) 651-3022
Mailing address
1410 WOODFAIR DR, RICHMOND, TX 77406-6609
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/24/2016
Last updated
07/24/2016
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