Individual
GARY DAVID PREMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
800 RIVERSIDE DR, WAUPACA, WI 54981-1943
(715) 258-1053
Mailing address
208 W WISCONSIN ST, WEYAUWEGA, WI 54983-9069
(715) 570-5889
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
979-039
WI
Other
Enumeration date
05/31/2009
Last updated
05/31/2009
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