Individual
MR. KUNTA-ALI G DUBOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2392 EDGEWOOD AVE N, JACKSONVILLE, FL 32254-1725
(904) 781-0611
(904) 781-0016
Mailing address
9536 PRINCETON SQUARE BLVD S APT 2305, JACKSONVILLE, FL 32256-8356
(904) 781-0600
(904) 781-0016
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/30/2012
Last updated
08/30/2012
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