Individual
MR. RAYMOND BONNER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1 LAKE PLACID LN, PALM COAST, FL 32137-9505
(386) 445-4680
Mailing address
1 LAKE PLACID LN, PALM COAST, FL 32137-9505
(386) 445-4680
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906652
FL
Other
Enumeration date
02/26/2014
Last updated
02/26/2014
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