Individual
MANNY LEE GARDUQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5163 CLEVELAND ST, VIRGINIA BEACH, VA 23462-6501
(757) 494-8828
Mailing address
5163 CLEVELAND ST, VIRGINIA BEACH, VA 23462-6501
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101Y00000X
VA
Other
Enumeration date
02/26/2016
Last updated
02/26/2016
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