Individual
VICTOR RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15430 COUNTY ROAD 565A # MAILBOXV, GROVELAND, FL 34736-8242
(954) 822-8212
Mailing address
15430 COUNTY ROAD 565A # MAILBOXV, GROVELAND, FL 34736-8242
(954) 822-8212
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
FL
Other
Enumeration date
11/12/2018
Last updated
11/12/2018
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