Individual
MR. KENNETH MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
751 ORANGE AVE, SAINT CLOUD, FL 34769-3063
(407) 967-7128
Mailing address
751 ORANGE AVE, SAINT CLOUD, FL 34769-3063
(407) 967-7128
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2083
FL
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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