Individual
MISS KIMBERLY JOAN GRAYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 TAMMY DR, SANFORD, FL 32771-3669
(407) 430-7483
Mailing address
300 TAMMY DR, SANFORD, FL 32771-3669
(407) 430-7483
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTA11181
FL
Other
Enumeration date
12/21/2010
Last updated
12/21/2010
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