Individual
BRENT LAWRENCE GUARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3449 E REZANOF DR, KODIAK, AK 99615-6952
(907) 486-1386
(907) 847-2264
Mailing address
PO BOX 127, LARSEN BAY, AK 99624-0127
(907) 486-1386
(907) 847-2264
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
18-135-BHA1
AK
Other
Enumeration date
06/18/2018
Last updated
06/18/2018
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