Individual
BRADLEY WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-4000
Mailing address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
40632
TN
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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