Individual
TANNER BOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
558 WADE STEWART ROAD, BUIES CREEK, NC 27506
(641) 224-2226
Mailing address
1305 S 10TH ST, LILLINGTON, NC 27546-5613
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-4887
NC
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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