Individual
LANCE BRYAN DEROSIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 N SHORT ST, FAIRCHILD AFB, WA 99011-9530
(425) 501-9301
Mailing address
PSC 1 BOX 631, APO, AE 09009-0007
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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