is a Adult Medicine in Lake Wales, Florida. practices all healthcare services and medical treatments related to Adult Medicine. The NPI Number for is 1477710366. The last update date is .
's current location address is 305 W Central Ave, Lake Wales, Florida. You can contact this provider via phone number 8662348534. The mailing address for is 305 W Central Ave, Lake Wales, Florida. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 305 W Central Ave, Lake Wales, Florida |
| Phone Number | 8662348534 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1477710366 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 305 W Central Ave |
|---|---|
| City | Lake Wales |
| State | Florida (FL) |
| Post Code | 338534015 |
| Phone Number | 8662348534 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Adult Medicine |
|---|---|
| Taxonomy | 207Qa0505X |
| Licence No | OS11541 |
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Definition: The NUCC recommends this code not be used. Choose a more appropriate code. |
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