Individual
ISRAEL FORNVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 KIMBERLEY DR, GREENVILLE, NC 27858-6722
(252) 757-1758
(252) 830-0077
Mailing address
105 KIMBERLEY DR, GREENVILLE, NC 27858-6722
(252) 757-1758
(252) 830-0077
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
7937489
NC
Other
Enumeration date
11/16/2022
Last updated
11/16/2022
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