Individual
MR. DEWAINE ALLEN OLSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
559 VINCENT ST, PETERSON AFB, CO 80914
(719) 474-3862
Mailing address
559 VINCENT ST, PETERSON AFB, CO 80914
(719) 474-3862
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
08/17/2009
Last updated
08/17/2009
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