Individual
VJACELSAVS ASME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
390 BURNINGTREE DR, GROTON, CT 06340-3106
(310) 863-1104
Mailing address
390 BURNINGTREE DR, GROTON, CT 06340-3106
(310) 863-1104
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/08/2025
Last updated
04/08/2025
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