Individual
GAYLEANN KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2901 AVENUE D, FORT PIERCE, FL 34947-2663
(772) 626-4456
Mailing address
2901 AVENUE D, FORT PIERCE, FL 34947-2663
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
01/15/2018
Last updated
01/15/2018
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