Individual
MR. JUSTIN GAROFOLO MANNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
614 GRAYSTONE AVE, JACKSONVILLE, NC 28540
(910) 581-0733
Mailing address
302 VENETIAN BLVD, LINDENHURST, NY 11757-6307
(910) 581-0733
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/28/2009
Last updated
08/28/2009
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