Individual
CASEY LEE BURNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
84 BOMBER RD, 726TH AIR CONTROL SQUADRON, MOUNTAIN HOME A F B, ID 83648-5272
(208) 828-3604
Mailing address
84 BOMBER RD, 726TH AIR CONTROL SQUADRON, MOUNTAIN HOME A F B, ID 83648-5272
(208) 828-3604
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
04/23/2009
Last updated
04/23/2009
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