Kyle Lee Bastie, CPO

NPI #1790960482 in Fredericktown, Missouri

Provider Information

NPI Number: 1790960482
Entity Type: Individual
Name: Kyle Lee Bastie, CPO
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Contractor
Credential: CPO
Enumeration Date: Jan 1, 2008
Last Updated: Jan 1, 2008

Practice Location

Address: 1432 MADISON 212
City: Fredericktown
State: Missouri
ZIP Code: 63645-8208
Phone: (520) 904-1079

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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