Individual
CAROLE STALLWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5116 MCMANUS DR, JACKSONVILLE, FL 32210-6353
(904) 703-0451
Mailing address
1264 HARBOUR TOWN DR, ORANGE PARK, FL 32065-2562
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/29/2019
Last updated
01/29/2019
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