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1417361882
MATTHEW FORTUNE
WINSTON SALEM, NC
NPI
1417361882
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist Athletic Trainer
(Licence: NC 2237)
Enumeration Date
2014-06-13
Last Update Date
2014-06-13
Business Address
MR. MATTHEW FORTUNE LAT, ATC
5705 SHATTALON DR
WINSTON SALEM, NC 27105-1332
Phone number: 336-399-5668
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Mailing Address
MR. MATTHEW FORTUNE LAT, ATC
5705 SHATTALON DR
WINSTON SALEM, NC 27105-1332
Phone number: 336-399-5668
Copy
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