Individual
KIM G ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
304 PONCE BLVD, SUITE 1, JACKSONVILLE, FL 32218-3863
(904) 504-4563
(904) 751-3906
Mailing address
11333 VERA DR, JACKSONVILLE, FL 32218-4159
(904) 504-4563
(904) 751-3906
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA30630
FL
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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