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Individual

CARRIE CONN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
IDC

Contact information

Practice address
4981 CATOCTIN DR APT 6, SAN DIEGO, CA 92115-2612
(757) 374-9167
Mailing address
4981 CATOCTIN DR APT 6, SAN DIEGO, CA 92115-2612
(757) 374-9167

Taxonomy

Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
CA

Other

Enumeration date
04/15/2015
Last updated
04/15/2015
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