Individual
RICHARD LEE COLONEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
143 MELROSE LANDING DR, HAWTHORNE, FL 32640-4417
(352) 642-5085
(877) 481-8035
Mailing address
PO BOX 571, HAWTHORNE, FL 32640-0571
(352) 642-5085
(877) 481-8035
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
C454752523700
FL
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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