Individual
ANDREW SUPPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
508 UPLAND ST, KENAI, AK 99611-8026
(907) 335-7500
Mailing address
508 UPLAND ST, KENAI, AK 99611-8026
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/03/2019
Last updated
05/03/2019
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