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Individual

GRANT MEDLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2498 LYNN LAKE CIR S, SAINT PETERSBURG, FL 33712-6117
(913) 553-9394
Mailing address
2498 LYNN LAKE CIR S, SAINT PETERSBURG, FL 33712-6117
(913) 553-9394

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
FL

Other

Enumeration date
09/25/2018
Last updated
09/25/2018
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