Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2006-02-06
- Last updated
- 2012-03-21
Licenses
- License FL
- 7G343A-C
Location
- Practice location
- 2901 YULE CT
- City
- CHRISTMAS FL
- Postal code
- 327098717
- Phone
- 407-568-6342
Organization contact
- Name
- MICHAEL PRUNER
- Title
- Administrator
- Phone
- 4079718115
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.