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Individual

BRYAN BROCE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
251 BALDWIN CT, WESTERVILLE, OH 43082-6005
(614) 456-8065
Mailing address
251 BALDWIN CT, WESTERVILLE, OH 43082-6005
(614) 456-8065

Taxonomy

Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
2107804
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0390971
OH
Enumeration date
12/22/2020
Last updated
12/22/2020
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