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Organization
PREMIER LIFE HEALTH SERVICES, LLC
Active
Organization
PREMIER LIFE HEALTH SERVICES, LLC
Active
Other names
Premier Healthcare of Florida
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KETTY MAURICE D.O. (PRESIDENT)
(407) 892-3627
Entity
Organization
Contact information
Practice address
4737 OLD CANOE CREEK ROAD, SAINT CLOUD, FL 34769-0000
(407) 892-3627
(407) 892-3625
Mailing address
PO BOX 702382, SAINT CLOUD, FL 34770-2382
(407) 892-3627
(407) 892-3625
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/31/2009
Last updated
09/24/2009
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