Individual
MR. MATTHEW KERMIT LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
465 TROUT AVE, NUMI, GROTON, CT 06340
(680) 666-6666
Mailing address
465 TROUT AVE, NUMI, GROTON, CT 06340
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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