Individual
MR. CASEY LEE GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
255 FRY ST, CHINA GROVE, NC 28023-6502
(704) 490-6885
Mailing address
255 FRY ST, CHINA GROVE, NC 28023-6502
(704) 490-6885
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
22874783
NC
Other
Enumeration date
10/04/2012
Last updated
11/16/2022
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