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1174964761
LESLIE JOHN MITKOS
CAMP LEJEUNE, NC
NPI
1174964761
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL 096.002508)
Enumeration Date
2013-07-11
Last Update Date
2017-03-21
Business Address
Mr. LESLIE JOHN MITKOS ATC
100 BREWSTER BLVD
CAMP LEJEUNE, NC 28547-2575
Phone number: 910-449-0324
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Mailing Address
Mr. LESLIE JOHN MITKOS ATC
619 CASTINE WAY
WILMINGTON, NC 28412-2763
Phone number: 217-494-7415
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