Organization
LIGHT WORKS WELLNESS CENTRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLYN J RANDOLPH L.M.T. (PRINCIPAL)
(386) 931-2212
Entity
Organization
Contact information
Practice address
4601 E HIGHWAY 100, SUITE B-8, BUNNELL, FL 32110-9017
(386) 437-5992
Mailing address
4601 E HIGHWAY 100, SUITE B-8, BUNNELL, FL 32110-9017
(386) 437-5992
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
MM12805
FL
Other
Enumeration date
07/30/2008
Last updated
07/30/2008
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