Individual
RUSSELL LEE SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
7513 BRITTANY LAKES DR, WILMINGTON, NC 28411
(910) 541-5341
Mailing address
7513 BRITTANY LAKES DR, WILMINGTON, NC 28411
(910) 541-5341
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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