Organization
AVANTI WELLNESS CENTER FLLLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RANDI B BRAZER LCSW (DIRECTOR OF OPERATIONS)
(904) 797-3115
Entity
Organization
Contact information
Practice address
3574 US 1 S, SUITE 113, ST AUGUSTINE, FL 32086-6466
(904) 797-3115
(904) 797-2915
Mailing address
3574 US 1 S, SUITE 113, ST AUGUSTINE, FL 32086-6466
(904) 797-3115
(904) 797-2915
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
77644
FL
Other
Enumeration date
05/14/2010
Last updated
02/28/2011
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