Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2016-06-13
- Last updated
- 2016-06-13
Licenses
- License FL
- Number not in the file
Location
- Practice location
- 2335 NW 142ND PL
- City
- CITRA FL
- Postal code
- 321133535
- Phone
- 352-361-7068
Organization contact
- Name
- FRESHEKA JOHNSON
- Title
- MGR
- Phone
- 3523617068
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.