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1386851574
GEORGE CONRAD FASTENAU
CAMP LEJEUNE, NC
NPI
1386851574
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2007-05-17
Last Update Date
2007-07-08
Business Address
-- GEORGE CONRAD FASTENAU Navy IDC
2ND CEB BAS 2D MARDIV II MEF
CAMP LEJEUNE, NC 28542
Phone number: 910-451-7989
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Mailing Address
-- GEORGE CONRAD FASTENAU Navy IDC
5179 COLORADO AVE
CAMP LEJEUNE, NC 28547-1126
Phone number: 910-451-7989
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