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Individual

MRS. DOMINIQUE V GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
122 E MAIN ST # 324, LAKELAND, FL 33801-4655
(863) 247-0273
(863) 291-3767
Mailing address
4530 S ORANGE BLOSSOM TRL, ORLANDO, FL 32839-1704
(689) 777-2847

Taxonomy

Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary

Other

Enumeration date
07/19/2024
Last updated
07/19/2024
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