Individual
MR. COREY LEE KISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3541 17TH CT, FOREST GROVE, OR 97116-2102
(503) 319-9763
Mailing address
3541 17TH CT, FOREST GROVE, OR 97116-2102
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/18/2012
Last updated
05/18/2012
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