Individual
MS. CHARLA JEAN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
601 E STRAWBRIDGE AVE, MELBOURNE, FL 32901-4733
(321) 984-7967
Mailing address
2553 AMBERLY RD NE, PALM BAY, FL 32905-2740
(321) 984-7967
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MM13301
FL
Other
Enumeration date
09/15/2009
Last updated
09/21/2009
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