Individual
ADAM GROSSNICKLAUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 SW CHRISTMAS TER, PORT SAINT LUCIE, FL 34984-4435
(772) 621-0032
Mailing address
230 SW CHRISTMAS TERRACE, PORT SAINT LUCIE, FL 34984
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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