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1710512009
MATTHEW DEFRIES
VIRGINIA BEACH, VA
NPI
1710512009
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
(Licence: IN 5060000751)
Enumeration Date
2020-03-06
Last Update Date
2023-06-22
Business Address
MATTHEW DEFRIES L02A
472 POLARIS ST BLDG 586
VIRGINIA BEACH, VA 23461-1935
Phone number: 219-869-1039
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Mailing Address
MATTHEW DEFRIES L02A
472 POLARIS ST BLDG 586
VIRGINIA BEACH, VA 23461-1935
Phone number:
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