Individual
KYLE JAMES DOMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
605 WASHINGTON STREET, FAYETTE, IA 52142
(630) 418-8352
Mailing address
605 WASHINGTON ST, FAYETTE, IA 52142-9206
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/02/2017
Last updated
09/02/2017
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