Individual
MR. JEREMY JON CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5110 S FLORIDA AVE STE 105, LAKELAND, FL 33813-2517
(863) 450-9864
Mailing address
5110 S FLORIDA AVE STE 105, LAKELAND, FL 33813-2517
(863) 450-9864
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/11/2011
Last updated
08/15/2011
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