Individual
MRS. JESSICA LEA PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
194 MAREADY RD, JACKSONVILLE, NC 28546-9332
(904) 240-9350
Mailing address
PSC BOX 20125, CLR-27 GROUP AID STATION, CAMP LEJEUNE, NC 28542-0125
(904) 240-3350
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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