Individual
DEBRA L VINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12720 KANSAS AVE, BLDG 789, FORT LEONARD WOOD, MO 65473
(573) 596-1470
(573) 596-1482
Mailing address
12720 KANSAS AVE, 720, FT. LEONARD WOOD, MO 65473
(573) 596-1470
(573) 596-1482
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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