Individual
EDEN STAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
259 BILL FRANCE BLVD, SUITE 200, DAYTONA BEACH, FL 32114-1316
(386) 206-8071
Mailing address
259 BILL FRANCE BLVD., SUITE 200, DAYTONA BEACH, FL 32114
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/28/2014
Last updated
08/17/2016
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