Individual
MR. KENNETH WAYNE GRAVES
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
NAVAL HOSPITAL CORPUS CHRISTI, 10651 E STREET, CORPUS CHRISTI, TX 78419-5130
(361) 961-3125
Mailing address
906 RED POLL CIRCLE, CORPUS CHRISTI, TX 78418
(361) 937-1294
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/08/2006
Last updated
07/08/2007
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