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Individual

MR. KYLE VERNARD WELLS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 228-7134
(503) 944-2595
Mailing address
4508 SE WOODWARD ST, PORTLAND, OR 97206-2238
(503) 771-1777

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary

Other

Enumeration date
02/06/2007
Last updated
07/08/2007
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