Organization
GENTLE ROOTS LLC
Active
Organization
GENTLE ROOTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIRA RIO BOGUSLAW D.O.M. (DOCTOR OF ORIENTAL MEDICINE)
(407) 803-1890
Entity
Organization
Contact information
Practice address
111 E 1ST ST, SANFORD, FL 32771-1301
(407) 803-1890
Mailing address
3040 FOXHILL CIR APT 108, APOPKA, FL 32703-8145
(407) 803-1890
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
AP3844
FL
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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