Individual
JOHNNIE MAE GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16277 SE HIGHWAY 19, CROSS CITY, FL 32628-3502
(352) 498-0338
(352) 498-3044
Mailing address
16277 SE HIGHWAY 19, CROSS CITY, FL 32628-3502
(352) 498-0338
(352) 498-3044
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/25/2013
Last updated
11/25/2013
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