Individual
MARY LOU DINICOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4149 S PINE ISLAND RD, DAVIE, FL 33328-2831
(954) 593-9735
(954) 689-3771
Mailing address
4149 S PINE ISLAND RD, DAVIE, FL 33328-2831
(954) 593-9735
(954) 689-3771
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA29513
FL
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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