Individual
KEPONO ALVIS ROSS GOWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
SNEADS FERRY RD, CAMP LEJEUNE, NC 28542
(910) 451-8155
Mailing address
229 CLAY HILL RD, SNEADS FERRY, NC 28460-9778
(808) 800-7450
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
NC
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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