Individual
ANDREW LEE BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
97 W MAIN ST, APT 47, NIANTIC, CT 06357-1749
(305) 492-5489
Mailing address
97 WEST MAIN ST, APT 47, NIANTIC, CT 06357-1731
(305) 492-5489
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
02/24/2011
Last updated
02/24/2011
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