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Individual

BRADLEY RUSSELL HEATER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
502 N LACKEY AVE, LOUISA, KY 41230-1206
(606) 483-1990
Mailing address
100 SHORT ST, LOUISA, KY 41230-1275
(502) 705-4891

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
KY

Other

Enumeration date
04/09/2024
Last updated
04/09/2024
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