Individual
KYLE K CROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1409 LINVILLE ST, KINGSPORT, TN 37664-2207
(423) 288-5399
(423) 288-4694
Mailing address
PO BOX 54, KINGSPORT, TN 37662-0054
(423) 288-5399
(423) 288-4694
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
00029481
TN
171WH0202X
Home Modifications Contractor
00029481
TN
Other
Enumeration date
03/14/2010
Last updated
03/14/2010
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