Individual
COLTON KEN DESSERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 BERGQUIST DR STE 1, JBSA LACKLAND, TX 78236-9908
(210) 292-7412
Mailing address
9132 TRUEMPER STREET, UNIT 9132, LACKLAND AFB, TX 78236
(916) 865-7567
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
06/14/2021
Last updated
06/14/2021
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