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Individual

GEORGE CONRAD FASTENAU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NAVY IDC

Contact information

Practice address
2ND CEB BAS 2D MARDIV II MEF, CAMP LEJEUNE, NC 28542
(910) 451-7989
Mailing address
5179 COLORADO AVE, CAMP LEJEUNE, NC 28547-1126
(910) 451-7989

Taxonomy

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

Other

Enumeration date
05/17/2007
Last updated
07/08/2007
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