Individual
HEATHER BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1835 GILMORE AVE, LAKELAND, FL 33805-3017
(863) 519-0575
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
(863) 519-0575
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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