Individual
MARY LAVALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 E SILVER SPRINGS BLVD, OCALA, FL 34470-6405
(352) 274-5070
Mailing address
4839 SW 63RD ST, OCALA, FL 34474-4781
(352) 274-5070
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA68058
FL
Other
Enumeration date
10/08/2012
Last updated
10/08/2012
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