Organization
KABS GOODWILL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADETOLA ADEYANJU-ISHOLA (MGR)
(813) 420-5885
Entity
Organization
Contact information
Practice address
2806 E BEARSS AVE, TAMPA, FL 33613-2653
(813) 420-5885
Mailing address
2806 E BEARSS AVE, TAMPA, FL 33613-2653
(813) 420-5885
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
ME102530
FL
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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