Organization
CMB-1 RETAILER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLINTON GEORGE BRYCE SR. (OWNER)
(863) 678-4808
Entity
Organization
Contact information
Practice address
1970 STATE ROAD 60 E, LAKE WALES, FL 33853-4369
(863) 678-4808
Mailing address
3661 JAPONICA AVE, INDIAN LAKE ESTATES, FL 33855
(863) 692-9189
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
440000
FL
Other
Enumeration date
05/27/2010
Last updated
05/27/2010
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