Individual
KATHRYN A LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 GALLBERRY CT, BUNNELL, FL 32110-6058
(386) 931-5755
Mailing address
16 GALLBERRY CT, BUNNELL, FL 32110-6058
(386) 931-5755
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
68927196
FL
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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