Individual
MR. MATTHEW LEE PENSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDEPENDENT DUTY CORP
Contact information
Practice address
814 RADFORD BLVD, ALBANY, GA 31704-9998
(229) 639-7886
Mailing address
814 RADFORD BLVD, ALBANY, GA 31704-1130
(229) 639-7886
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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