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Individual

DAVID RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CBHT

Contact information

Practice address
1407 DIXON BLVD, COCOA, FL 32922-6411
(321) 452-0800
Mailing address
1407 DIXON BLVD, COCOA, FL 32922-6411
(321) 452-0800

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
5024
FL

Other

Enumeration date
03/26/2013
Last updated
03/26/2013
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